Physical Medicine & Rehabilitation Service, VA Eastern Colorado Health Care System, 1055 Clermont Street (117), Denver, CO 80220; Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine, Aurora, CO.
Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora; and Physical Medicine & Rehabilitation Service, VA Eastern Colorado Health Care System, Denver, CO.
PM R. 2018 May;10(5):544-547. doi: 10.1016/j.pmrj.2017.10.003. Epub 2017 Oct 24.
A 30-year-old man with no significant medical history presented with hypokalemic quadriplegia 4 hours after he received a lumbar transforaminal epidural steroid injection (ESI) containing dexamethasone and lidocaine. A comprehensive workup ruled out acquired and hereditary causes of hypokalemic paralysis. Symptoms gradually resolved within hours after potassium restoration with no residual neurologic deficits. Paralysis after transforaminal ESI is uncommon but has been associated with particulate steroids that can coalesce into aggregates and occlude vessels. To our knowledge, there have been no case reports of paralysis after ESI with dexamethasone, a nonparticulate steroid. This transient paralysis is possibly caused by the effects of glucocorticoids on Na-K channels and insulin resistance resulting in hyperglycemia and subsequent hypokalemia. We reviewed the differential diagnosis of transient paralysis after epidural steroid injection in this report.
IV.
一名 30 岁男子，既往无重大病史，在接受含有地塞米松和利多卡因的腰椎经椎间孔硬膜外类固醇注射（ESI）后 4 小时出现低钾性四肢瘫痪。全面的检查排除了获得性和遗传性低钾性瘫痪的原因。补钾后数小时内症状逐渐缓解，无残留神经功能缺损。经椎间孔 ESI 后发生瘫痪并不常见，但与可聚集成团并阻塞血管的颗粒状类固醇有关。据我们所知，尚无地塞米松（一种非颗粒状类固醇）注射后发生瘫痪的病例报告。这种短暂性瘫痪可能是糖皮质激素对钠钾通道的影响以及胰岛素抵抗导致高血糖和随后的低钾血症引起的。在本报告中，我们回顾了硬膜外类固醇注射后短暂性瘫痪的鉴别诊断。
IV 级。
