Sharma Kartavya, Sharma Vibhash D
Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Neurosciences Critical Care division, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
Pain Manag. 2016 Oct;6(5):421-5. doi: 10.2217/pmt-2016-0014. Epub 2016 Jul 25.
We report a case of a 48-year-old man with chronic back pain attributed to discogenic lumbar radiculopathy who underwent a fluoroscopy-guided L2-3 interlaminar epidural steroid injection. 4 h later, he developed acute paraparesis, sensory loss below T10 level and urinary retention. MRI of the thoracic spine revealed diffuse abnormal T2/FLAIR signal and extensive vascular flow voids. A spinal dural arteriovenous fistula was confirmed on spinal angiography. Embolization of the spinal dural arteriovenous fistula resulted in significant improvement of symptoms. We review previously reported cases and current understanding of the pathophysiology of this complication. All cases had symptom onset several hours after the procedure. There seems to be a trend toward better outcomes with earlier treatment.
我们报告一例48岁男性，因椎间盘源性腰椎神经根病导致慢性背痛，接受了透视引导下L2-3椎板间硬膜外类固醇注射。4小时后，他出现急性下肢轻瘫、T10水平以下感觉丧失和尿潴留。胸椎MRI显示弥漫性T2/液体衰减反转恢复序列（FLAIR）信号异常及广泛的血管流空。脊髓血管造影证实为脊髓硬脊膜动静脉瘘。脊髓硬脊膜动静脉瘘栓塞后症状显著改善。我们回顾了先前报道的病例以及对该并发症病理生理学的当前认识。所有病例均在手术后数小时出现症状。早期治疗似乎有更好的预后趋势。
