Acute developing transient paraparesis after celiac plexus block: MRI findings

Abstract

Purpose An endometrium cancer with liver metastasis, developing continuous and severe abdominal pain with vomiting and constipation, following phenol celiac plexus neurolysis, is described to find out if MRI can explain the reason of neurologic deficit. Materials and methods A 81-year-old woman with metastatic endometrium cancer underwent celiac plexus phenol neurolysis for management of severe pain at right hypochondriacal region. In spite of apparently adequate needle position, she developed transient paraplegia consistent with anterior spinal artery syndrome. At 48 h after celiac plexus block MRI was performed. Results In this patient, paraplegia suddenly ensued after instillation of the phenol solution, and postprocedure spinal MRI showed increased signal in the thoracic spinal cord consistent with edema. The patient was discharged 25 days after the block with clinically insignificant neurological deficit. Conclusion We present a case of a patient who had paraparesis after the performance of celiac plexus block (CPB). We propose that the mechanism for this rare but devastating complication is the neurotoxicity of phenol on spinal cord which may result from spasmotic effect of phenol on spinal feeding arteries. In such cases MRI, especially the short tau inversion recovery (STIR) sequence should be performed to see the acute changes in spinal cord in patients with acute developing neurologic deficit following CPB.