Recovery after high-dose methylprednisolone and delayed evacuation - A case of spinal epidural hematoma

Spinal epidural hematoma (SEH) is rare and not without serious sequelae. We report a patient who developed Brown-Sequard syndrome from SEH after fluor oscopic-guided cervical steroid injection and favorable response to methylp rednisolone (NIP). A 56-year-old man reported immediate sharp shooting pain to the upper extremities on introduction of epidural toughy needle. A tota l of 5 mL of 0.2% ropivacaine and 120 mg methylprednisolone acetate suspens ion was administered at the C6-7 interspace. Within half an hour, a neurolo gic deficit occurred at C7-8 and right Brown-Sequard syndrome developed. On ce SEH was suspected (3 hours after onset of neurologic deficit), a protoco l of high-dose MP intravenous infusion was initiated. Immediate incomplete recovery of motor, sensory, and sphincteric functions was noted within 30 m inutes of infusion. Emergency spinal C6-T2 bilateral decompressive laminect omies and evacuation SEH were performed within an expected delay (10 hours from the onset of neurologic deficit). Fluoroscopic guidance does not take the place of adherence to meticulous technique. An unexplained neurologic d eficit after invasive spinal procedures should raise the concern for SEH. E arly recognition and emergent evacuation remain the mainstay management for SEH. This case suggests some neuroprotection from IMP in cases of cervicot horacic cord compression secondary to traumatic SEH. When potential risks f or SEH exist, it is advisable not to administer local anesthetic so as not to interfere with neurologic assessment and delaying the diagnosis.