Newly Published
Images in Anesthesiology  |   July 2019
Spinal Epidural Hematoma after Interlaminar Cervical Epidural Steroid Injection
Author Notes
  • From the Department of Anesthesiology (R.K.B.) and Department of Neurosurgery (C.C.C.C.), University of Minnesota, Minneapolis, Minnesota.
  • Correspondence: Address correspondence to Dr. Banik: rkbanik@umn.edu
Article Information
Images in Anesthesiology / Central and Peripheral Nervous Systems / Obstetric Anesthesia
Images in Anesthesiology   |   July 2019
Spinal Epidural Hematoma after Interlaminar Cervical Epidural Steroid Injection
Anesthesiology Newly Published on July 29, 2019. doi:10.1097/ALN.0000000000002896
Anesthesiology Newly Published on July 29, 2019. doi:10.1097/ALN.0000000000002896
The exact incidence of spinal epidural hematoma after cervical epidural steroid injection is unknown, but the incidence of epidural hematoma after epidural block in obstetric patients is estimated to be ~1:200,000.1  The computed tomography images above demonstrate an epidural hematoma in an 80-yr-old woman after C7–T1 epidural injection performed under moderate sedation. Thirty minutes after the procedure, she developed acute onset of neck pain, which progressed shortly to numbness down to her mid-sternum, 0/5 strengths in the bilateral elbows, wrists, and lower extremities, and loss of patellar-reflexes. The image was taken ~3 h after the onset of symptoms. Image A is a sagittal computed tomography image, which is notable for hyperdense collection of blood within the spinal canal extending from C2–T4. Image B is a cross-sectional view at the level of C7, which shows a biconvex-shaped hyperdense lesion within the spinal canal suggestive of epidural hematoma. The patient’s localized neck pain, quadriplegia, loss of reflexes, numbness, sudden onset of symptoms, and computed tomography findings are characteristic of acute cord compression.