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Brainstem stroke following uncomplicated cervical epidural steroid injection
Wendy C Ziai1, Agnieszka A Ardelt, Rafael H Llinas
1Divisions of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. weziai@jhmi.edu
Archives of Neurology
|November 15, 2006
Summary
Cervical epidural steroid injections for radicular pain can lead to severe complications. A case report details a fatal hemorrhagic brainstem infarction following a methylprednisolone acetate injection, highlighting potential risks.
Area of Science:
- Neurology
- Pain Management
- Radiology
Background:
- Cervical epidural steroid injections are frequently used for radicular pain.
- Methylprednisolone acetate is a common corticosteroid used in these procedures.
Observation:
- A 41-year-old patient experienced severe neurological symptoms post-injection.
- Symptoms included extensive brainstem and thalamic infarction with hemorrhagic conversion.
Findings:
- Magnetic resonance imaging and autopsy confirmed widespread infarction and hemorrhage.
- Hemorrhage within the adventitia of the vertebral artery at C5 was noted.
- Hydrocephalus was also present.
Implications:
- This case highlights serious intracranial pathology risks from cervical epidural steroid injections.
- Vascular spasm distant from the injection site is a potential mechanism.
- Fluoroscopic guidance may not prevent all severe complications.
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