Methylprednisolone acetate
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Worsening of paraparesis: case report A 53-year-old man developed worsening of the paraparesis following analgesic therapy with methylprednisolone acetate. The man had underlying well-controlled HIV infection and Buerger disease. He was on various concomitant medications. He presented with cramps, paresis and hypoaesthesia of his toes that slowly progressed proximally. After 7 months, he reported hypoaesthesia and paraparesis of the entire lower limbs that limited his walking perimeter to a few metres aided by two crutches. He was eventually diagnosed with severe sensory-motor axonal polyneuropathy. Owing to the severe symptoms and severe lower back pain, he received epidural methylprednisolone acetate 80mg injection into the L4–L5 medullar epidural space. However, methylprednisolone acetate worsened the paraparesis within hours, with a 3/5 MRC score for the lower limbs. Also, he developed acute cauda equina syndrome within hours of the injection administration [exact time to reaction onset not stated]. Moreover, a Th10 sensory hypoaesthesia level and urinary retention were noted. This eventually resulted in impairment of daily living activities. A whole spine MRI demonstrated Th9-L1 intramedullary hypersignal while a MR angiography confirmed these findings and revealed serpiginous vascular structures posterior to the spinal cord at the Th10-Th11 level. Due to the high clinical and radiological suspicion for an ongoing spinal dural arteriovenous fistula, two spinal angiographies were performed and individualised Th5-L3 pedicles were noted, without any fistula. Finally, a third medullar arteriogram revealed left Th4 perimedullary fistula. The man was therefore hospitalised and underwent a surgical electrocoagulation of the shunting zone. Eventually, he regained autonomy of all the daily living activities. However, his strength deteriorated one month later, and a repeat angiograph revealed a new post-surgical arteriovenous fistula [aetiology not stated]. Le Goueff A, et al. Acute paraparesis after epidural corticosteroid injection revealing spinal dural arteriovenous fistula in a HIV patient. European Journal of Case Reports in 803518303 Internal Medicine 7: No. 10, 2020. Available from: URL: http://doi.org/10.12890/2020_001673
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Reactions 5 Dec 2020 No. 1833
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