Article

A 30-year-old man with no significant medical history presented with hypokalemic
quadriplegia 4 hours after he received a lumbar transforaminal epidural steroid
injection (ESI) containing dexamethasone and lidocaine.
A comprehensive workup
ruled out acquired and hereditary causes of hypokalemic paralysis. Symptoms
gradually resolved within hours after potassium restoration with no residual
neurologic deficits. Paralysis after transforaminal ESI is uncommon but has been
associated with particulate steroids that can coalesce into aggregates and
occlude vessels. To our knowledge, there have been no case reports of paralysis
after ESI with dexamethasone, a nonparticulate steroid. This transient paralysis
is possibly caused by the effects of glucocorticoids on Na-K channels and insulin
resistance resulting in hyperglycemia and subsequent hypokalemia. We reviewed the
differential diagnosis of transient paralysis after epidural steroid injection in
this report. LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS