Association between lumbar epidural injection and development of acute paraparesis in patients with spinal dural arteriovenous fistulas.
We report 3 patients with previously undiagnosed spinal dural arteriovenous fistulas (SDAVFs), who developed acute paraparesis following lumbar epidural steroid injection. MR imaging demonstrated spinal cord T2 hyperintensity, edema and/or enhancement of the conus, and intradural enlarged vascular flow voids. Spinal angiography confirmed SDAVFs arising from pedicles remote from the sites of the epidural steroid injection. Fistulas were eliminated with either endovascular or combination endovascular and open surgical approaches, with subsequent partial resolution of paraparesis.
Hetts
S W
SW
Department of Radiology, the Neurovascular Medical Group, UCSF Medical Center, San Francisco, CA, USA. steven.hetts@radiology.ucsf.edu
Narvid
J
J
Singh
T
T
Meagher
S
S
Corcoran
K
K
Higashida
R T
RT
Dowd
C F
CF
Halbach
V V
VV
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D000792:Angiography; D020785:Central Nervous System Vascular Malformations / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology* / Q000601:surgery; D013129:Spinal Puncture / Q000009:adverse effects*
D000305:Adrenal Cortex Hormones