Stroke following Epidural Injections—Case Report and Review of Literature

Abstract

Infarction is a rare but potentially devastating complication of CESI. It may occur despite the use of fluoroscopic guidance.

Spinal Vascular Lesions

“…A case of cervical cord infarction was associated with the use of sildena fi l (Viagra, P fi zer, New York, NY) 169 b. Epidural steroid injections, in which the agent is inadvertently injected in arteries supplying the cord. [170][171][172] i. Risk of cord ischaemia may be higher in transforaminal injections.…”

Epidural Steroid Injections

“…Psychologically, systemic steroids have been implicated in a range of symptoms from depression to euphoria to the welldescribed steroid psychosis. Neurologically, steroids have been shown to cause symptoms that vary from simple headaches to ischemic neuropathy, seizure, and stroke [77]. In the cardiovascular system, the main concern lies with hypertension because steroid use can result in edema formation, increased systemic vascular resistance, and augmented cardiac contractility.…”

Particulate versus non-particulate steroids for lumbar transforaminal or interlaminar epidural steroid injections: an update

“…Death as well as infarction of cerebellum, brain stem, thalamus, cervical, and lumbar spinal cord have been reported after cervical and lumbar epidural injections, either by an interlaminar or transforaminal approach [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. In the literature, all 17 thoracolumbar spinal cord infarctions related to lumbosacral epidural steroid injection were associated with particulate steroids whereas no case of paraplegia was described after image-guided epidural injection of dexamethasone [16][17][18][19][20][21][22][23][24][25][26].…”

“…The following corticosteroids were associated with ischemic stroke of the spinal cord or the posterior cerebral circulation after epidural spinal injections: triamcinolone acetonide, betamethasone, methylprednisolone acetate, and prednisolone acetate [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. No patient in the literature suffered from an ischemic event after cervical or lumbosacral epidural imageguided injection of dexamethasone [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…No patient in the literature suffered from an ischemic event after cervical or lumbosacral epidural imageguided injection of dexamethasone [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”