Fatal embolism of the anterior spinal artery after local cervical analgetic infiltration.
A 66-year-old man received a local infiltration of cortisone and xylocain in the left paravertebral region between the fifth and sixth cervical vertebrae. Respiratory failure occurred 2.5 h later with subsequent successful resuscitation. During the following 2 months of assisted ventilation up to the patients death, tetraplegia with concurrent full consciousness throughout was observed. Magnetic resonance imaging confirmed an ischaemic lesion of the upper anterior cervical myelon. The forensic autopsy revealed pneumonia as cause of death. Neuropathology confirmed anterior infarction at the C2/C3 level of the cervical myelon, with obstruction of the anterior spinal artery by an epithelialised fibrocartilaginous embolus. The autoptic findings suggest that this embolus stems from the site of previous analgetic infiltration, with accidental laceration of an intervertebral disc and subsequent transportation of discous material via injection canula into an artery.
Meyer
Harald J
HJ
Institute of Forensic Medicine, Salzburg University, Ignaz-Harrerstr. 79, A-5020 Salzburg, Austria. harald.meyer@sbg.ac.at
Monticelli
Fabio
F
Kiesslich
Jan
J
D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000209:etiology; D002356:Cartilage; D002574:Cervical Vertebrae; D003348:Cortisone / Q000008:administration & dosage / Q000009:adverse effects*; D004617:Embolism / Q000150:complications / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D007238:Infarction / Q000209:etiology; D007278:Injections, Spinal / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D011782:Quadriplegia / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D013116:Spinal Cord / Q000098:blood supply
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008012:Lidocaine; D003348:Cortisone