Methylprednisolone/sodium chloride
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Exacerbation of an arteriovenous fistula, leading to paraparesis: case report A 62-year-old man was hospitalised for progressive lower limb weakness and paraesthesia. Findings were suggestive of an inflammatory or neoplastic process of the spine, and he started receiving daily IV methylprednisolone 1g in 500mL of saline. He reported leg pain and weakness 2 hours after the first bolus. An examination revealed worsening of his initial symptoms, with paraparesis (2/5) and hypoalgesia at L2 level. Methylprednisolone was temporarily held and his symptoms returned to baseline 48 hours later. Methylprednisolone was restarted, but his symptoms recurred after the second dose and therapy was discontinued. On MRI, abnormal vessels were noted in the lumbar subarachnoid space, and angiography confirmed a dural arteriovenous fistula (DAVF). Author comment: "In our case, the almost immediate (two hour) clinical aggravation following steroid therapy and the fact that the same phenomenon happened twice, suggest a [causal] relationship. . . [T]he rapid infusion of saline solution, which the methylprednisolone was diluted, as well as the effect of hydrosaline retention produced by the drug, could result in an increase in volemia and, secondary, in venous pressure." Cabrera M, et al. Acute paraparesis following intravenous steroid therapy in a case of dural spinal arteriovenous fistula. Journal of Neurology 255: 1432-1433, No. 9, 801118783 Sep 2008 - Spain
0114-9954/10/1230-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 29 Nov 2008 No. 1230
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