Perils of Intravascular Methylprednisolone Injection into the Vertebral Artery

Abstract

These data suggest that one etiology of neurologic complications following cervical nerve blocks may be inadvertent intravascular injection of particulate steroids, as all animals injected with methylprednisolone had neurologic deficits while none of the controls injected with non-particulate steroids were affected. To our knowledge, this study is the first to demonstrate that particulate steroids cause neurologic deficits and to suggest that use of non-particulate steroids might prevent such complications.

Selective Cervical Nerve Root Blockade: Prospective Study of Immediate and Longer Term Complications

“…Okubadejo et al 36 injected the vertebral artery of 11 pigs with different steroid preparations and examined the brains and cervical spinal cords by MR imaging and histology. Four pigs received particulate steroid (methylprednisolone, 40 mg/ mL).…”

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

“…In addition, histopathology showed ischemic brain and spinal cord injury after the intra-arterial injection of particulate steroids consistent with a cerebrovascular insult. In contrast, animals that underwent intra-arterial injection of non-particulate steroids while under general anesthesia demonstrated full clinical recovery after the termination of general anesthesia and did not show any evidence of neurologic injury on MR images or histopathology [52]. This investigation in an animal model proposes that inadvertent intra-arterial injections of particulate steroids are associated with neurologic complications whereas intra-arterial non-particulate injections are safer compared to particulate steroids [52].…”

“…Particulate steroids (methylprednisolone acetate) and nonparticulate steroids (dexamethasone sodium phosphate, prednisolone sodium succinate) were injected into the vertebral artery of 11 swine while the animals were under general anesthesia [52]. All animals receiving intra-arterial particulate steroids failed to regain consciousness after the injection, required mechanical ventilation to replace spontaneous breathing, and MRI revealed cervical cord and brain stem edema.…”

Particulate Matter in Injectable Drug Products

“…The inadvertent intravascular injection of corticosteroid formulations containing particles has been linked to adverse central nervous system sequelae in humans not observed with non-particulate steroid formulations (24). A study involving pigs injected in the vertebral artery with particulate-or non-particulatebased steroids yielded similar results, with pigs receiving the particulate-containing steroids displaying brain stem edema and significant tissue damage (25).…”