Recovery after high-dose methylprednisolone and delayed evacuation - A case of spinal epidural hematoma

被引:30
作者
Ghaly, RF
机构
[1] Chicago Inst Neurosurg & Neurores, Chicago, IL 60614 USA
[2] Cook Cty Hosp, Dept Anesthesiol & Pain Management, Chicago, IL 60612 USA
关键词
cervical steroid injection; pain management; methylprednisolone; spinal cord injury; spinal epidural hematoma;
D O I
10.1097/00008506-200110000-00008
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Spinal epidural hematoma (SEH) is rare and not without serious sequelae. We report a patient who developed Brown-Sequard syndrome from SEH after fluoroscopic-guided cervical steroid injection and favorable response to methylprednisolone (NIP). A 56-year-old man reported immediate sharp shooting pain to the upper extremities on introduction of epidural toughy needle. A total of 5 mL of 0.2% ropivacaine and 120 mg methylprednisolone acetate suspension was administered at the C6-7 interspace. Within half an hour, a neurologic deficit occurred at C7-8 and right Brown-Sequard syndrome developed. Once SEH was suspected (3 hours after onset of neurologic deficit), a protocol of high-dose MP intravenous infusion was initiated. Immediate incomplete recovery of motor, sensory, and sphincteric functions was noted within 30 minutes of infusion. Emergency spinal C6-T2 bilateral decompressive laminectomies and evacuation SEH were performed within an expected delay (10 hours from the onset of neurologic deficit). Fluoroscopic guidance does not take the place of adherence to meticulous technique. An unexplained neurologic deficit after invasive spinal procedures should raise the concern for SEH. Early recognition and emergent evacuation remain the mainstay management for SEH. This case suggests some neuroprotection from IMP in cases of cervicothoracic cord compression secondary to traumatic SEH. When potential risks for SEH exist, it is advisable not to administer local anesthetic so as not to interfere with neurologic assessment and delaying the diagnosis.
引用
收藏
页码:323 / 328
页数:6
相关论文
共 39 条
[21]  
La Rosa G, 1999, J NEUROSURG, V91, P128
[22]   Spinal epidural hematoma associated with warfarin therapy [J].
Lederle, FA ;
Cundy, KV ;
Farinha, P ;
McCormick, DP .
AMERICAN JOURNAL OF MEDICINE, 1996, 100 (02) :237-238
[23]   NONTRAUMATIC SPINAL EPIDURAL AND SUBDURAL HEMATOMAS [J].
MATTLE, H ;
SIEB, JP ;
ROHNER, M ;
MUMENTHALER, M .
NEUROLOGY, 1987, 37 (08) :1351-1356
[24]   RECOVERY FROM PARAPLEGIA CAUSED BY SPONTANEOUS SPINAL EPIDURAL HEMATOMA [J].
MCQUARRIE, IG .
NEUROLOGY, 1978, 28 (03) :224-228
[25]   EFFECT OF METHYLPREDNISOLONE IN COMPRESSION TRAUMA TO THE FELINE SPINAL-CORD [J].
MEANS, ED ;
ANDERSON, DK ;
WATERS, TR ;
KALAF, L .
JOURNAL OF NEUROSURGERY, 1981, 55 (02) :200-208
[26]   Steroids and spinal cord injury: Revisiting the NASCIS 2 and NASCIS 3 trials [J].
Nesathurai, S .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1998, 45 (06) :1088-1093
[27]   COMPLICATIONS OF INTRATHECAL OPIOIDS AND BUPIVACAINE IN THE TREATMENT OF REFRACTORY CANCER PAIN [J].
NITESCU, P ;
SJOBERG, M ;
APPELGREN, L ;
CURELARU, I .
CLINICAL JOURNAL OF PAIN, 1995, 11 (01) :45-62
[28]  
NOTH I, 1993, AM J PEDIAT HEMATOL, V15, P131
[29]   Conservative treatment of acute spontaneous spinal epidural hematoma [J].
Pahapill, PA ;
Lownie, SP .
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES, 1998, 25 (02) :159-163
[30]   Spontaneous spinal epidural hematoma in children [J].
Patel, H ;
Boaz, JC ;
Phillips, JP ;
Garg, BP .
PEDIATRIC NEUROLOGY, 1998, 19 (04) :302-307