Acute Intracranial Subdural Hematoma After Epidural Steroid Injection: A Case Report

Özdemir, Özgür; Calisaneller, Tarkan; Yıldırım, Erkan; Altınörs, Nur

doi:10.1016/j.jmpt.2007.07.005

Cited by 25 publications

(20 citation statements)

References 10 publications

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“…35,38 Haemorrhagic complications associated with the procedure include acute subdural as well as epidural and subarachnoidal haematomas. 41,42 From the neurological standpoint there may be transient motor weakness, cauda equina syndrome (very few cases reported) with symptoms usually resolving within hours or days; there may also be direct neurological damage. [43][44][45] Metabolic adverse events, associated with steroid use, include hyperglicemia with blood sugar levels derangement lasting at least 2 weeks in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of epidural methylprednisolone in radicular pain

Correa

Díaz

Lotero

2015

Colombian Journal of Anesthesiology

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a b s t r a c tIntroduction: Degenerative disc disease is a prevalent and disabling disease. When the conservative treatment fails to obtain pain relief, epidural steroids are an alternative frequently used worldwide.Objectives: To evaluate the efficacy and safety of epidural methylprednisolone in patients with radicular pain.Methodology: Descriptive longitudinal retrospective study in patients with chronic radicular pain who received fluoroscopy-guided interventional treatment, between July 2010 and December 2011 at Instituto Colombiano del Dolor (Medellín-Colombia), to determine the efficacy and safety of epidural methylprednisolone in clinical practice. Pain relief was followed using the visual analogue scale, during at least 8 weeks.Results: 254 patients were analyzed. The mean age of the patients was 52.8 years (SD ± 15); 52.8% were men. The main diagnosis was lower-limb radicular pain (87.7%). The most frequent procedures were transforaminal lumbar injection (54.3%) and interlaminar lumbar injection (17.7%). The proportion of patients with more than 50% pain relief 50% was 85.8%.There were no differences in efficacy between the procedures. Pain improvement lasted more than 8 weeks in 55% of patients. The incidence of complications was lower than 1%.Conclusions: When radicular pain is refractory to conservative treatment based on pharmacological and physical therapy, epidural methylprednisolone is an effective and safe method in our setting.

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Section: Discussionmentioning

confidence: 99%

Efficacy of epidural methylprednisolone in radicular pain

Correa

Díaz

Lotero

2015

Colombian Journal of Anesthesiology

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“…In turn, dural punctures occasionally have been reported to cause postdural puncture headaches (PDPHs), owing to leakage of cerebrospinal fluid (CSF) 3) . Although one case of a scanty intracranial acute subdural hematoma after lumbar ESI has been reported previously 9) , an intracranial chronic subdural hematoma (CSDH) following ESI has never been reported in the literature. To the best of our knowledge, we here report the first case of an intracranial CSDH following cervical ESI, and discuss the clinical importance of a persistent headache after ESI.…”

Section: Introductionmentioning

confidence: 99%

Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection

Kim

Park

2015

J Korean Neurosurg Soc

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Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

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“…It is more common among young women. 3 Initially, PDPH was considered to be the most likely cause of the patients headache in this case as there were no neurological signs and the pain responded intermitently to treatment. However, upon obtaining further history and progression of symptoms and findings of diplopia on neurogical examination led to a braoder differential diagnosis and further testing uncoverd an intracranial hemorrhage.…”

Section: Discussionmentioning

confidence: 95%