Introduction Ganglion impar block (GIB) is a well-recognised treatment for chronic coccydynia. Several side effects have previously been described with this procedure, including transient motor dysfunction, bowel, bladder, and sexual dysfunction, neuritis, rectal perforation, impingement of the sciatic nerve, cauda equina syndrome, and infection. Case presentation We describe the first report of imaging-documented conus infarction after an unguided-GIB performed in theatre using particulate steroids for a 17-year-old patient with coccydynia. Immediately post-GIB, patient developed transient neurological deficits in her lower limbs of inability to mobilise her legs that lasted for 24 h. These include back and leg pain, decreased power and movement, increased tone, brisk reflexes, reduced light touch sensation and proprioception of legs up to the T10 level. Urgent MRI spine showed intramedullary hyperintense signal within the conus and mild restricted diffusion on the distal cord and conus, suggestive of an acute conus infarction. On follow-up, the GIB did not result in symptom improvement of coccydynia and there was persistent altered sensation of her legs. Discussion Various approaches of ganglion impar block have been described and performed in the past with different imaging techniques and injectants. A few cases of unusual neurological complications have been reported with the use of epidural steroid injections and ganglion impar block. Clinicians should be aware of the possible neurological complications following ganglion impar blocks and the risk of inadvertent intravascular injection of particulate steroids can potentially to be minimised by using imaging guidance.
Gelatinous transformation of bone marrow (GTBM) is a hematological condition found to be associated with states of cachexia and malnourishment, which can be seen in patients with eating disorders, alcoholism, malignancy, and other systemic diseases (such as AIDS, tuberculosis, chronic kidney disease, and chronic heart failure). GTBM is not disease-specific but is a good marker of a severe underlying disease. Initially thought to be a rare finding, newer literature is now demonstrating more cases of GTBM over the past 2 decades, and the alleged rarity may have been attributed to the lack of clinical suspicion and awareness of this condition. We present a case of a young adult female, who has a background of anorexia nervosa and presented with a 4-month history of pain over her left shin. Magnetic resonance imaging (MRI) of the tibia demonstrated the gelatinous transformation of the bone marrow. In this case report, we aim to highlight the underlying pathogenesis of GTBM and its prevalence, its unique distribution within the marrow, its characteristic MRI findings, and how these findings may differ in comparison to normal reconversion marrow and neoplastic infiltration.
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