CASE REPORT   

Journal of Radiological Review 2021 December;8(4):311-5

DOI: 10.23736/S2723-9284.21.00144-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Persistent triplegia and cranial nerve dysfunction after lysis of epidural adhesions

Marco LA GRUA ^{1, 2}, Irene GRAZZINI ³ ✉, Gian L. CUNEO ⁴, Gianfranco SINDACO ^{1, 2}, Matteo ZANELLA ^{1, 2}, Simone VIGNERI ^{1, 2}, Francesca M. VINCI ^{1, 2}, Chiara SCIACCA ^{1, 2}, Alberto MERLINI ^{1, 2}, Gilberto PARI ^{1, 2}

¹ Department of Pain Medicine, Santa Maria Maddalena Hospital, Occhiobello, Rovigo, Italy; ² Advanced Algology Research, Rimini, Italy; ³ Section of Neuroradiology, Department of Radiology, San Donato Hospital, Arezzo, Italy; ⁴ Vesalio Radiological Institute, Grosseto, Italy

Lysis of epidural adhesions is a well-known interventional mini-invasive technique indicated for refractory pain in failed back surgery syndrome. Even if infrequent, complications after procedure have been reported transient in most cases; however, in rare instances, epidural lysis may cause severe sequelae. In this study, we described the case of a 44-year-old female with a diagnosis of failed back surgery syndrome, who underwent lysis of epidural adhesions based on the Racz technique. Two hours after the procedure, she developed nausea and vomiting, headache, nuchal rigidity, diplopia, and bilateral hypoesthesia in the lower limbs. Neurological examinations 36 hours after the procedure revealed a worsening of the clinical status, with onset of dysphagia, paralysis in the left upper limb, and subsequent progressive paraplegia. Radiological imaging showed diffuse involvement of the brainstem and of the spinal cord, with multiple ischemic and hemorrhagic lesions and brain subarachnoid hemorrhage. The patient complained of persistent left hemiplegia and mild cranial nerve impairment at the 6-month follow-up session. A partial spread of the injected drugs onto the subarachnoid space during the procedure, demonstrated by epidurography, caused vasospasm with impaired flow in the cerebral and anterior spinal vessels.

KEY WORDS: Magnetic resonance imaging; Epidural space; Failed back surgery syndrome