Multiple intracerebral hemorrhages after cervical epidural injections

Abstract

Epidural steroid injections are commonly used to treat chronic pain secondary to radiculopathy. Complications of epidural injections include unintentional dural puncture, vasovagal syncope, apnea, and hypotension. Cervical epidural injections are associated with higher rates of complications than lumbar or caudal epidural injections.1 Recent American Academy of Neurology guidelines do not recommend epidural injections for radicular pain.2 We report a rare complication of low CSF pressure headache and multiple simultaneous intraparenchymal hemorrhages, occurring 7 days after cervical epidural injection. ### Case report. A 36-year-old left-handed woman with a history of a motor vehicle accident 1 year prior to admission presented with left-sided weakness and paresthesias of her right hand. She had chronic cervical neck pain since her motor vehicle accident, and was treated with a series of four cervical epidural anesthetic injections. She had no complications following the first three injections. The patient then had a fourth cervical epidural injection with no indication of dural puncture. However, approximately 4 days after this epidural injection she developed a positional, holoacranial, throbbing headache. The headache became severe when she was in the upright or sitting position and dramatically decreased with …