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Paraplegia Following Lumbar Epidural Steroid Injection in a Patient With a Spinal Dural Arteriovenous Fistula

Annaswamy, Thiru M. MD, MA; Worchel, Jared DO, MS

American Journal of Physical Medicine & Rehabilitation: August 2017 - Volume 96 - Issue 8 - p e147–e150
doi: 10.1097/PHM.0000000000000645
Case Reports

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.

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.

All correspondence and requests for reprints should be addressed to: Thiru M. Annaswamy, MD, MA, Physical Medicine & Rehabilitation Service, Veterans Affairs North Texas Health Care System, 4500 S. Lancaster Rd, Dallas, TX 75216.

This case report is exempt from institutional review board approval according to our institution’s guidelines and conforms to all CARE guidelines and reports the required information accordingly (see Supplementary Checklist and Supplementary Timeline [http://links.lww.com/PHM/A343, http://links.lww.com/PHM/A344]).

There were no grants providing funding for this case report.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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