Steroid psychosis: a cause of confusion on the acute spinal cord injury unit.

The use of glucocorticoids has long been known to be associated with a number of side effects. The current use of high-dose methylprednisolone in spinal cord injured patients puts this population at increased risk. In particular, the risk of acute psychotic reactions is increased because it is a dose response relationship. Conservative estimates report an incidence of 5.7%. These reactions place the patient at increased risk of further spinal cord injury and worsening neurologic deficit. We present two cases of possible steroid psychosis in which the mental status changes did indeed place the patients at risk of further injury.