Hemorrhagic Infarction of Cerebellum and Brainstem Due to Cervical Epidural Steroid Injection

Abstract

Radiculopathy is a painful condition usually due to a compressed nerve in the spine. It is reported that cervical radiculopathy has an annual incidence of 83.2 cases per 100 000 people. Cervical epidural steroid injection is one of the main treatments, but it can result in serious adverse events, including loss of vision, stroke, paralysis, and death.

A 69-year-old female died after receiving the second of three planned C5/C6 epidural steroid injections. The autopsy revealed extensive hemorrhage and necrosis of the entire right side of the cerebellum and nearby brainstem, and extensive petechial hemorrhage of the left side of the cerebellum.

This report discusses the importance of a complete autopsy in the case of death due to cervical epidural steroid injection and reporting the case either to peer review literature or to the Food and Drug Administration Adverse Event Reporting System (F AERS) database.

Keywords

Forensic pathology Steroid injection Death Cerebellar infarction

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References

Scanlon

Moeller-Bertram

Romanowsky

Wallace

. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine (Phila Pa 1976). 2007 May 15; 32(11):1249–56. PMID: 17495784. https://doi.org/10.1097/BRS.0b013e318053ec50.

Benny

Azari

Briones

. Complications of cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil. 2010 Jul; 89(7): 601–7. PMID: 20567139. https://doi.org/10.1097/PHM.0b013e3181e2d07c.

Epstein

. The risks of epidural and transforaminal steroid injections in the spine: commentary and a comprehensive review of the literature. Surg Neurol Int. 2013 Mar 22; 4(Suppl 2): S74–93. PMID: 23646278. PMCID: PMC3642757. https://doi.org/10.4103/2152-7806.109446.

Epstein

. Major risks and complications of cervical epidural steroid injections: an updated review. Surg Neurol Int. 2018 Apr 23; 9:86. PMID: 2974050.7 PMCID: PMC5926212. https://doi.org/10.4103/sni.sni_85_18.

Popescu

Lai

Gardner

. Stroke following epidural injections – case report and review of literature. J Neuroimaging. 2013 Jan; 23(1):118–21. PMID: 21699610. https://doi.org/10.1111/j.1552-6569.2011.00615.x.

U.S. Food and Drug Administration [Internet]. Silver Spring (MD): U.S. Department of Health and Human Services; c2018. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain; 2014 Apr 23 [cited 2018 Jul 28]. Available from: https://www.fda.gov/Drugs/DrugSafety/ucm394280.htm.

Hemorrhagic Infarction of Cerebellum and Brainstem Due to Cervical Epidural Steroid Injection – Case Report and Review of the Literature

Abstract

Keywords

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References