Triamcinolone
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Iatrogenic spinal cord infarction: case report A 44-year-old woman developed iatrogenic spinal cord infarction following a CT-guided cervical periradicular pain therapy with triamcinolone. The woman, who had uncontrollable cervical brachial syndrome on left C7 dermatome, was hospitalised for a CT-guided periradicular pain therapy. Two weeks previously, a cervical CT-guided infiltration had revealed a discrete vasovagal reaction. Due to the persistent radicular residual complaints to the left C7 dermatome, a further CT-guided infiltration via an anterolateral access pathway in the neck was performed in a supine position at approximately 30° to the contralateral side of the neck. According to the standard protocol of the hospital, a 21-gauge (0.7mm), 6cm long needle was inserted under slow incremental steps and concurrent local anaesthesia with lidocaine [Xylanaest] was administered in the posterior area of the neuroforamen along the intervertebral joint. After negative aspiration and CT-verification of extravascular and/or periradicular distribution of the test injection of iomeprol [Iomeron 300], bupivacaine [Bucain] and 10mg (1mL) of triamcinolone [Volon A] suspension was administered. Immediately thereafter, she experienced increasing respiratory distress which rapidly worsened. Therefore, the woman received artificial ventilation. She subsequently developed a tetraparesis. One day later, an MRI examination showed symmetric, T2w sequence hyperintense signal alterations in the anterior horns of C3-C6, consistent with ischaemic myelopathy. The neurological symptoms continued to improve during 2-month hospitalisation. Subsequently, she was moved to a rehabilitation clinic with incomplete tetraparesis, restored respiratory function and stool and urinary continence. Schnedl C, et al. Iatrogener Ruckenmarksinfarkt nach CT-gesteuerter zervikaler periradikularer Schmerztherapie. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 192: 349-350, No. 4, Apr 2020. Available from: URL: http://doi.org/10.1055/a-1024-4466 [German; summarised from a translation] 803507810
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Reactions 17 Oct 2020 No. 1826
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