TITLE

Perils of Intravascular Methylprednisolone Injection into the Vertebral Artery

AUTHOR(S)
Okubadejo, Gbolahan O.; Talcott, Michael R.; Schmidt, Robert E.; Sharma, Aseem; Patel, Alpesh A.; Mackey, R. Brian; Guarino, Anthony H.; Moran, Christopher J.; Riew, K. Daniel
PUB. DATE
September 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;Sep2008, Vol. 90-A Issue 9, p1932
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Intravascular injection of particulate steroids during cervical nerve root blocks has been postulated to be a source of catastrophic neurologic complications that might be avoided with the use of non-particulate steroids. The objective of this study was to compare the effects of direct intravascular injection of particulate and non-particulate steroids on the spinal cord and central nervous system. Methods: Eleven adult pigs underwent direct injection, under fluoroscopic guidance, into the vertebral artery while under general anesthesia. A particulate steroid (methylprednisolone) was injected into four animals (Group 1), whereas seven animals received a non-particulate steroid (dexamethasone in four animals [Group 2] and prednisolone in three [Group 3]). Following injection, the animals were assessed by direct observation of physical activity and with magnetic resonance imaging. After the animals were killed, brain and spinal cord material was retrieved, fixed in paraformaldehyde for one week, and then subjected to histopathologic analysis. Results: All four animals in Group 1 failed to regain consciousness after the injection and required ventilatory support. The animals in Groups 2 and 3 recovered fully and demonstrated no evidence of neurologic injury. Magnetic resonance imaging revealed upper cervical cord and brain stem edema in Group 1, but not in Groups 2 and 3. Histologic analysis showed early evidence of hypoxic and ischemic damage—specifically, early eosinophilic neuronal necrosis, nuclear condensation, white-matter pallor, and extracellular edema—in Group 1 but not in Groups 2 and 3. Conclusions: 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.
ACCESSION #
34230453

 

Related Articles

  • Episodic itch in a case of spinal glioma. Wolking, Stefan; Lerche, Holger; Dihné, Marcel // BMC Neurology;2013, Vol. 13 Issue 1, p1 

    Background: Itch is a frequent complaint reported by patients and is usually ascribed to dermatological or metabolic causes. In neurological disorders, however, it is a very unusual symptom and thus its neurological aetiology is likely to be overlooked. There are only very few reports about...

  • Effect of intranasally administered cholecystokinin on encoding of controlled and automatic memory processes. Schneider, Ronald; Osterburg, Judith; Buchner, Axel; Pietrowsky, Reinhard // Psychopharmacology;Mar2009, Vol. 202 Issue 4, p559 

    The neuropeptide cholecystokinin (CCK) is present in abundance in the central nervous system, where it is involved in the regulation of a wide range of functions. It also takes part in the modulation of memory processes, but its effect on human memory systems and processes is not yet well...

  • The effects of yohimbine and amphetamine on fear expression and extinction in rats. Mueller, Devin; Olivera-Figueroa, Lening; Pine, Daniel; Quirk, Gregory // Psychopharmacology;Jul2009, Vol. 204 Issue 4, p599 

    Psychostimulants, such as yohimbine and amphetamine, can enhance learning and memory. Extinction of conditioned fear involves new learning, so we asked whether psychostimulants could enhance this learning. Previous work suggests that yohimbine facilitates extinction, using freezing as a fear...

  • Gamma knife radiosurgery for central neurocytoma: long-term outcome and failure pattern. J. W. Kim; D. G. Kim; H. Chung; J. H. Han; Y. Kim; C. Kim; S. H. Paek // Journal of Radiosurgery & SBRT;2013 Supplement 2.1, Vol. 2, p153 

    Recently, radiosurgery has highlighted it important as a primary or a secondary treatment for central neurocytoma (CN). Owing to the scarcity of CN, most clinical studies have been based on case series with limited number of patients as well as relatively short follow-up periods. Therefore, it...

  • Treating relapsing-remitting multiple sclerosis: therapy effects on brain atrophy. Vidal-Jordana, Angela; Sastre-Garriga, Jaume; Rovira, Alex; Montalban, Xavier // Journal of Neurology;Dec2015, Vol. 262 Issue 12, p2617 

    Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system with a complex and heterogeneous pathology that may ultimately lead to neurodegeneration and brain atrophy. Brain volume loss in MS is known to occur early in the disease course and to be clinically relevant, as...

  • Predicting Outcome after Epidural Steroid Injection. Rubin, Michael // Neurology Alert;Jan2012, Vol. 30 Issue 5, p38 

    Response to treatment of unilateral lumbar radiculopathy can be predicted by an abnormal needle EMG in the appropriate root distribution.

  • Effects of an aqueous extract of North American ginseng on MOG(35-55)-induced EAE in mice. Bowie, Laura E.; Roscoe, Wendi A.; Lui, Ed M. K.; Smith, Robin; Karlik, Stephen J. // Canadian Journal of Physiology & Pharmacology;Jul2012, Vol. 90 Issue 7, p933 

    Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, in which the release of reactive oxygen species by infiltrating immune cells contributes to demyelination. American ginseng (Panax quinquefolius) is a natural health product with numerous beneficial...

  • Pharmacokinetics and Pharmacodynamics of Antiretrovirals in the Central Nervous System. Calcagno, Andrea; Perri, Giovanni; Bonora, Stefano // Clinical Pharmacokinetics;Oct2014, Vol. 53 Issue 10, p891 

    HIV-positive patients may be effectively treated with highly active antiretroviral therapy and such a strategy is associated with striking immune recovery and viral load reduction to very low levels. Despite undeniable results, the central nervous system (CNS) is commonly affected during the...

  • Methylphenidate and impulsivity: a comparison of effects of methylphenidate enantiomers on delay discounting in rats. Slezak, Jonathan; Ricaurte, George; Tallarida, Ronald; Katz, Jonathan // Psychopharmacology;Jan2014, Vol. 231 Issue 1, p191 

    Rationale: Current formulations of methylphenidate (MPH) used in treatment of attention-deficit/hyperactivity disorder (ADHD) result in significantly different bioavailability of MPH enantiomers. Daytrana, a dl-MPH transdermal patch system, produces higher levels of l-MPH than when dl-MPH is...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics