Dangers From Methylprednisolone Acetate Therapy by Intraspinal Injection

Nelson, Dewey A.

doi:10.1001/archneur.1988.00520310122029

Cited by 127 publications

(32 citation statements)

References 27 publications

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“…It has also been included as an often-used orthodox therapy in an orthopaedic text of the gold standard class 9 . The most dreaded complication was epidural abscess 5,11,21 and localized infection of various forms 31,37 , whereas complications such as meningitis 3,40 and arachnoiditis 27,34,45 occurred rarely 4,13,48 and only in subdural injections 28,30,39 or not at all 12,17,38 . Other rare forms such as retinal haemorrhage, myopathy and lipomatosis associated with Cushing's syndrome have also been reported.…”

Section: Introductionmentioning

confidence: 99%

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Loy

2000

J Orthop Surg (Hong Kong)

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The effects of epidural injections of triamcinolone acetonide and bupivacaine in the treatment of sciatica were analyzed in a retrospective series of 526 consecutive cases with measurements. A new test (the whistle test) is described. There is a paucity of measureable parameters in reports on the subject in the literature, and many are not specific or symptomoriented to sciatica. The procedure was performed by the same operator and reviewed one week postoperatively with measurements. 491 patients (93.35%) achieved excellent to good pain relief, backed by appropriate increases of straight-leg-raise measurements. But 17 patients (3.46%) of this group required surgery later. It is concluded that epidural steroid injection is a simple, cost-effective and minimally invasive treatment for sciatica, especially in the acute. It also serves as a method for crisis intervention and as a prognosticator.

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Section: Introductionmentioning

confidence: 99%

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Loy

2000

J Orthop Surg (Hong Kong)

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“…However, intraspinal injections may be made intrathecally or epidurally, and reported cases arachnoiditis have followed an intrathecal injection. 9,10 Furthermore, arachnoid villi subtend the subarachnoid, subdural, and epidural spaces, and thus, inflammation caused by an epidural injection can spread. The other danger associated with epidural injections is that the epidural space is entered 'blindly' during injection.…”

Section: Discussionmentioning

confidence: 99%

“…These anatomical features and technical errors during injection largely explain the development of arachnoiditis following epidural injection. 9 The delayed occurrence of spinal arachnoiditis is rare but not unprecedented. Several articles have reported cases of spinal arachnoiditis with a delayed symptom onset following spine procedures or diseases.…”

Section: Discussionmentioning

confidence: 99%

Delayed occurrence of spinal arachnoiditis following a caudal block

Han

Kim

2011

The Journal of Spinal Cord Medicine

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Context: Spinal arachnoiditis is a rare disease caused by fibrosis and adhesion of the arachnoid membrane due to chronic inflammation. The causes of arachnoiditis are infection, spinal surgery, intraspinal injection of steroid or myelography dye, and spinal anesthesia. Method: Case report. Findings: A 60-year-old woman presented with progressive weakness and sensory change of both legs and urinary symptoms. She had received a single caudal block 6 months before symptom onset. Magnetic resonance imaging of the thoraco-lumbar spine showed an intradural extramedullary tumor at the T5-T7 level. She underwent laminectomy and tumor resection. The pathological finding was arachnoiditis. After surgery, a rehabilitation program of strengthening exercises of both lower extremities and gait training was started. At 2-month follow-up, she was able to walk with orthoses and performed daily activities with minimal assistance. Conclusion: Symptoms of spinal arachnoiditis occurred 6 months after a single caudal block in this woman. Clinicians should be aware of this possible delayed complication.

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“…These agents are all highly irritating to soft tissues. 7,15,16 2) We agree that PGS may also be avoided by using an alternative antiepileptic drug (AED). The purpose of our study was not to evaluate the rationale use of IV PHT or fosphenytoin.…”

Section: Giuliano Geminiani MD Milan Italymentioning

confidence: 99%

Bilineal transmission in Tourette syndrome

1999

Neurology

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1could be related to abnormal integration of CVAR. We studied heart rate (HR) change on deep breath (HRdb), initial HR increase on standing (beats/min) (HRst), and 30:15 ratio in 20 AD patients (age 56 -79 years) and 20 age-matched controls (table). MannWhitney and Student t-test were used.We found patients with normal HRdb showing normal cardiovagal brainstem reflexes. Patients also had normal HRst but without subsequent HR decrease (30:15 ratio), indicating normal initial vagal modulation but defective further HR regulation. 2 It is possible that cardioinhibitory carotid sinus hypersensitivity in AD patients 1 could be explained by normality of afferent limb of the carotid sinus reflex and of cardiac vagal brainstem function but with loss of inhibition from cortical regions. Cardiovascular instability with spontaneous hypotension accompanied by slow cortical EEG activity and normal HRdb was reported in one AD patient. 3 The clinical relevance of abnormal CVAR integration in AD needs further study. Dopamine agonists reorient visual exploration away from the neglected hemispaceTo the Editor: I read with interest Grujic et al.'s recent article on the effect of bromocriptine on visual exploratory behavior in patients with visuospatial neglect after right hemisphere stroke. 1 As the authors note, my colleagues and I also observed that bromocriptine can increase ipsilesional motor-intentional bias.2 Our patient took 20 mg daily at the time when we assessed his performance, and other studies of bromocriptine treatment for neglect in humans 3,4 have slowly increased the daily dose to a presumed therapeutic range of at least 15 mg/d. Grujic et al. do not discuss why they chose a small dose (2.5 mg), and I wonder if they would be willing to explain. It would seem, based on their findings, that clinicians using bromocriptine for neglect may wish to reassess soon after instituting therapy as well as at "therapeutic dose." Anna M. Barrett, MD, Gainesville, FL To the Editor: The study by Grujic et al.1 on the role of the dopaminergic system in visual exploration in unilateral neglect is interesting not only for its implications on clinical practice and rehabilitation, but also for its theoretical aspects, which bear on the pathophysiology of directed attention in unilateral neglect. Although animal studies have shown that the dopaminergic system is involved in explorative behavior, 5,6 studies on humans in this area are limited. 3,7 Grujic et al. show that a single dose of the dopaminagonist bromocriptine accentuates exploration on the side ipsilateral to the lesion, resulting in worsening of left neglect. This finding conflicts with the results of Fleet et al.3 who reported an improvement in human unilateral neglect with chronic administration of bromocriptine. Grujic et al. also found that dopaminergic stimulation has different effects on the exploratory-motor and sensoryperceptual components of directed attention. This aspect was explored in our own study 7 in which acute stimulation with apomorphine produced a t...

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Dangers From Methylprednisolone Acetate Therapy by Intraspinal Injection

Cited by 127 publications

References 27 publications

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Delayed occurrence of spinal arachnoiditis following a caudal block

Bilineal transmission in Tourette syndrome

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