Complications of Lumbar Puncture with Injection of Hydrosoluble Material

Hoeffel, Christine; Gaucher, H; Chevrot, A.; Jc, Hoeffel

doi:10.1097/00002517-199904000-00016

Cited by 9 publications

(6 citation statements)

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“…Flushing is a well documented side effect with corticosteroid administration (7)(8)(9)(10)(11)(13)(14)(15). Flushing has been studied via various routes of epidural administration (7)(8)(9)(10)15,19,20).…”

Section: Discussionmentioning

confidence: 99%

Flushing Following Interlaminar Lumbar Epidural Steroid Injection with Dexamethasone

Kim

2010

Pain Phys

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Background: Epidural steroid injections are commonly used in managing radicular pain. Most complications related to epidural injections are minor and self-limited. Flushing is considered as one such minor side effect. Flushing has been studied using various steroid preparations including methylprednisone, triamcinolone, and betamethasone but its frequency has never been studied using dexamethasone. Objective: This study evaluates the frequency of flushing associated with fluoroscopyguided lumbar epidural steroid injections using dexamethasone. Study Design: Retrospective cohort design study. Patients presenting with low back pain were evaluated and offered a fluoroscopically guided lumbar epidural steroid injection using dexamethasone via an interlaminar approach as part of a conservative care treatment plan. Setting: University-based Pain Management Center. Intervention: All injections were performed consecutively over a 2-month period by one staff member using 16 mg (4 mg/mL) of dexamethasone. A staff physician specifically asked each participant about the presence of flushing following the procedure prior to discharge on the day of injection and again on follow-up within 48 hours after the injections. The answers were documented as “YES” or “NO.” Results: A total of 150 participants received fluoroscopically guided interlaminar epidural steroid injection. All participants received 16 mg (4 mg/mL) of dexamethasone with 2 mL of 0.2% ropiviciane. Overall incidence of flushing was 42 out of 150 cases (28%). Of the 42 participants who experienced flushing, 12 (28%) experienced the symptom prior to discharge following the procedure. Twenty-seven of the 42 (64%) were female (P < 0.05). All the participants who experienced flushing noted resolution by 48 hours. No other major side effects or complications were noted. Limitations: Follow-up data were solely based on subjective reports by patients via telecommunication. Follow-up time was limited to only 48 hours, which overlooks the possibility that more participants might have noted flushing after the 48 hour limit. Conclusions: Flushing is commonly reported following epidural steroid injections. With an incidence of 28%, injections using dexamethasone 16 mg by interlaminar epidural route appear to be associated with more flushing reaction than previously reported with other steroid preparations. Additionally, female participants are more likely to experience flushing though the reactions seem to be self-limiting with resolution by 48 hours. Key words: flushing, side effects, epidural, back pain, lumbar, steroid, dexamethasone, injections.

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Section: Discussionmentioning

confidence: 99%

Flushing Following Interlaminar Lumbar Epidural Steroid Injection with Dexamethasone

Kim

2010

Pain Phys

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“…A review of the literature was published in 1937 13 and comprised 200 cases of chemical meningitis secondary to intrathecal injections of anesthetic agents, lipiodol, serum and air. The most frequent cases were observed with isotope cisternography, 14,15 intrathecal corticosteroid injections (hydrocortisone acetate, methylprednisolone acetate [16][17][18][19][20] and methylprednisolone in a polyethylene glycol vehicle (Depomedrol s ) 21 ), aminoglycosides 22 and spinal anesthetics. 23,24 This led Merritt and Fremont-Smith to the conclusion that intrathecal injection of 'any foreign material may cause aseptic meningitis'.…”

Section: Discussionmentioning

confidence: 99%

Aseptic meningitis after intrathecal baclofen injection

Bensmaïl¹,

Peskine²,

Denys³

et al. 2005

Spinal Cord

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Study design: Two case reports of aseptic meningitis after intrathecal baclofen injection. Objectives: To report an unusual complication of intrathecal baclofen injection during test injections. Setting: Department of Neurological Rehabilitation, R Poincare´Hoˆpital (Paris-Ile de FranceOuest University). Case reports: We present two cases of chemical meningitis after intrathecal baclofen injections by lumbar puncture. These cases presented with febrile meningeal syndromes during the 24 h following intrathecal baclofen injection. Direct cerebrospinal fluid (CSF) examination and CSF cultures were negative. An intense cellular reaction was observed with a marked predominance of neutrophils. Meningitis resolved spontaneously over 3-4 days. Conclusions: Chemical meningitis is a rare complication of intrathecal baclofen injections that must be recognized. It is a diagnosis of exclusion and its pathophysiological mechanism remains unclear.

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“…Numerous other molecules have been suspected of being responsible for DIAMs, such as allopurinol [86,87], azathioprine [88], cytarabine [89,90], salazopyrine [91,92], and intramuscular methotrexate [93]. Chemical meningitis is a particular entity described after the intrathecal injection of a large number of molecules such as radiographic agents [30], corticosteroids [94][95][96][97][98][99], aminoglycosides [100], bupivacain [101][102][103], morphine [23], interferon (IFN) [24], and baclofene [22,104]. Three categories could be suspected [105] as follows: infection, chemical irritation, and patient-specific reaction(s).…”

Section: Miscellaneousmentioning

confidence: 99%

Drug‐induced aseptic meningitis: a mini‐review

Yéléhé‐Okouma

Czmil-Garon

Pape

et al. 2018

Fundamemntal Clinical Pharma

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Aseptic meningitis associates a typical clinical picture of meningitis with the absence of bacterial or fungal material in the cerebrospinal fluid. Drug-induced aseptic meningitis (DIAM) may be due to two mechanisms: (i) a direct meningeal irritation caused by the intrathecal administration of drugs and (ii) an immunologic hypersensitivity reaction to a systemic administration. If the direct meningeal irritation allows a rather easy recognition, the immunologic hypersensitivity reaction is a source of challenging diagnostics. DIAM linked to a systemic treatment exerts typically an early onset, usually within a week. This period can be shortened to a few hours in case of drug rechallenge. The fast and spontaneous regression of clinical symptoms is usual after stopping the suspected drug. Apart from these chronological aspects, no specific clinical or biological parameters are pathognomonic. CSF analysis usually shows pleiocytosis. The proteinorachia is increased while glycorachia remains normal. Underlying pathologies can stimulate the occurrence of DIAM. Thus, systemic lupus erythematosus appears to promote DIAM during NSAID therapy, especially ibuprofen-based one. Similarly, some patients with chronic migraine are prone to intravenous immunoglobulin-induced aseptic meningitis. DIAM will be mainly evoked on chronological criteria such as rapid occurrence after initiation, rapid regression after discontinuation, and recurrence after rechallenge of the suspected drug. When occurring, positive rechallenge may be very useful in the absence of initial diagnosis. Finally, DIAM remains a diagnosis of elimination. It should be suggested only after all infectious causes have been ruled out.

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Complications of Lumbar Puncture with Injection of Hydrosoluble Material

Cited by 9 publications

References 0 publications

Flushing Following Interlaminar Lumbar Epidural Steroid Injection with Dexamethasone

Flushing Following Interlaminar Lumbar Epidural Steroid Injection with Dexamethasone

Aseptic meningitis after intrathecal baclofen injection

Drug‐induced aseptic meningitis: a mini‐review

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