Epidural Steroid Injection Complicated by Intrathecal Entry, Pneumocephalus, and Chemical Meningitis

Shah, Aakash Kaushik; Bilko, Andrey; Takayesu, James Kimo

doi:10.1016/j.jemermed.2016.05.040

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…Two days after initiating symptomatic treatment, the patient’s symptoms completely resolved. Because pneumocephalus was observed in these three cases, 6–8 inadvertent dural puncture might have occurred during the procedure. Although there were no findings indicative of pneumocephalus in our case, there was a high risk of unintended intrathecal entry of the injected solution.…”

Section: Discussionmentioning

confidence: 91%

“…9 Although several reports have described chemical meningitis caused by local anesthetics after spinal anesthesia or intrathecal anesthetics and/or steroid injection, 10–13 only three cases of chemical meningitis after epidural injection for pain management have been reported. 6–8 In 1987, Gutknecht 6 reported a case of chemical meningitis after interlaminar epidural injection at the L12–1, L4–5, and L5–S1 levels with methylprednisolone for treatment of lower back pain and lumbar radicular pain. The patient’s symptoms developed 4 hours after the epidural injection, and brain CT revealed air droplets in the subarachnoid space.…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, Shah et al. 8 reported a case of chemical meningitis with pneumocephalus. The symptoms developed 1.5 hours after the epidural injection of lidocaine, methylprednisolone, and betamethasone.…”

Section: Discussionmentioning

confidence: 99%

“…However, because the course of each disorder is not fully elucidated, clinicians should initiate empirical treatment with broad-spectrum antibiotics until the CSF culture results are available. 8…”

Section: Discussionmentioning

confidence: 99%

“…3–5 Moreover, chemical meningitis is a potential adverse effect of epidural injection. 6–8 This condition can cause several symptoms, such as headache, neck stiffness, fever, nausea/vomiting, and an altered mental status. 6–8 In all reported cases, chemical meningitis occurred after interlaminar lumbar epidural injection.…”

Section: Introductionmentioning

confidence: 99%

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Chemical meningitis after cervical transforaminal epidural steroid injection: a case report

Lee

2021

J Int Med Res

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We herein report a case of chemical meningitis that developed after cervical transforaminal steroid injection. A 49-year-old man presented with symptoms of meningitis (severe headache and neck stiffness) after cervical transforaminal steroid injection at the right C5–6 level. The injection solution was a mixture of lidocaine (0.3 mL), hyaluronidase (1 mL), placenta hydrolysate (2 mL), and normal saline (1 mL). The patient developed symptoms of meningitis 2.5 hours after the cervical epidural injection. Cerebrospinal fluid (CSF) analysis was performed 1 day after the injection, and the results showed an elevated white blood cell count at 7106 cells/µL. The patient’s CSF analysis findings and symptoms did not differ from those of bacterial meningitis. However, considering that his symptoms developed 2.5 hours after the epidural injection, we believe that the patient developed chemical meningitis; therefore, he was symptomatically treated with an analgesic. Three days after the cervical transforaminal epidural injection, the patient experienced complete relief from the headache and neck stiffness. A Gram stain of the CSF revealed no organisms. Hence, the diagnosis of chemical meningitis was confirmed. Clinicians should be knowledgeable about the risk of this complication.

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Section: Discussionmentioning

confidence: 91%