title: Paraplegia Following Lumbar Epidural Steroid Injection in a Patient With a Spinal Dural Arteriovenous Fistula.
abstract: We report a patient with a previously undiagnosed spinal dural arteriovenous fistula (SDAVF) who became acutely paraplegic following a lumbar epidural steroid injection for lumbar spinal stenosis. Magnetic resonance imaging showed multiple flow voids and serpentine vessels on the cord surface with cord edema extending from T3 through the conus. Spinal angiography confirmed an SDAVF fed by the left lateral sacral artery, which was subsequently endovascularly embolized, and the patient had a partial return of function. Presence of an undiagnosed SDAVF should be considered in patients presenting with lower-extremity weakness without pain and considered a contraindication to lumbar epidural steroid injection.
authors: From the Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center (TMA, JW); and Physical Medicine & Rehabilitation Service, Veterans Affairs North Texas Health Care System (TMA), Dallas, Texas.
authors: Thiru M
authors: TM
authors: Annaswamy
authors: Jared
authors: J
authors: Worchel
mesh_terms: D000792:Angiography / Q000379:methods; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis*; D000075202:Contraindications; D057210:Delayed Diagnosis / Q000009:adverse effects*; D006801:Humans; D007268:Injections, Epidural; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000139:chemically induced*; D013130:Spinal Stenosis / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D013256:Steroids