- Department of Neurosurgery, University of Washington, Seattle, Washington, United States.
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States.
Zaid Aljuboori, Department of Neurosurgery, University of Washington, Seattle, Washington, United States.
DOI:10.25259/SNI_737_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Zaid Aljuboori1, Brian Williams2. Spinal intramedullary hematoma presenting years following a cervical epidural injection. 30-Aug-2021;12:430
How to cite this URL: Zaid Aljuboori1, Brian Williams2. Spinal intramedullary hematoma presenting years following a cervical epidural injection. 30-Aug-2021;12:430. Available from: https://surgicalneurologyint.com/surgicalint-articles/11079/
Background: Intramedullary cervical cystic lesions are typically attributed to tumors, infection, or trauma. Here, a patient newly presented with quadriparesis due to a chronic cervical intramedullary hematoma attributed to a cervical epidural steroid injection (CESI) performed 4 years earlier.
Case Description: A 38-year-old patient had a CESI in 2014. Resulting in a transient quadriparesis attributed to an inadvertent intramedullary cord injection. Now, at age 42, she presented with a recurrent cervical myelopathy due to an MR-documented C3-C6 intramedullary cystic lesion that at surgery proved to be a chronic liquified hematoma rather than a syrinx.
Conclusion: CESI can result in inadvertent intramedullary hemorrhages and spinal cord injuries. Here, a 42-year-old female presented with recurrent myelopathy due to a chronic intramedullary C3-C6 cervical hematoma attributed a prior intramedullary CESI injection performed 4 years previously.
Keywords: Epidural, Injection, Intramedullary, Hematoma, Spine
Intramedullary cervical cystic lesions are typically attributed to; intramedullary tumors, syringomyelia, hematomyelia, and intramedullary abscesses.[
A now 42-year-old patient underwent a CESI for neck pain in 2014. The procedure was aborted when she developed the acute onset of electrical shock sensations (Lhermitte’s Signs) running down the entire spine and a transient quadriparesis (i.e., that lasted 1 week). Four years later, the patient presented with a recurrent quadriparesis attributed to a cervical MRI-documented intramedullary cyst spanning the C3-C6 levels that did not enhance with contrast. Although the original diagnosis was an idiopathic syrinx, at surgery consisting of a myelotomy, it proved to be a chronic liquified hematoma [
(a) Preoperative MRI T1 sequence of the cervical spine (sagittal view) shows a cystic lesion involving the cervical spinal cord (*). (b) Preoperative MRI T2 sequence of the cervical spine (sagittal view) shows a cystic lesion involving the cervical spinal cord (*). (c) Preoperative MRI T1 sequence with contrast of the cervical spine (sagittal view) shows a cystic lesion involving the cervical spinal cord (*). (d) Intraoperative image (×50) shows the midline myelotomy (*) to decompress the cyst. (e) Intraoperative image (×50) shows the old liquified hematoma emerging from the myelotomy (*). (f) Postoperative MRI T2 sequence of the cervical spine (sagittal view) shows the spinal cord after decompression of the intramedullary hematoma (*).
The differential diagnosis of intramedullary cervical cord cystic lesions include; primary and metastatic tumors, syringomyelia, hydromyelia, infection, and hematomyelia.[
Delayed chronic spinal cord intramedullary hematomas can develop, as in this case, up to 4 years following CESI. Here, direct surgical decompression resulted not only in neurological improvement, but also confirmed the diagnosis of an intramedullary hematoma attributed to the prior CESI.
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