Abstract Details

Title Cervical Facet Joint Injection and Fatal Cerebritis: A Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P06 - (-)

Poster/Presentation
Number 262

Objective

Background BACKGROUND: Facet joint injections are used for the treatment of cervicogenic headache (CH). Limited knowledge is available regarding neurological complications of CFJI. To our knowledge, fatal complications are rare. We report a case of fatal neurological event in a patient who received a facet joint injection (FJI).

Design/Methods DESIGN/METHODS: Case Report.

Results RESULTS: 68 year old female with history of Rheumatoid arthritis and CH was transferred from a Pain Clinic to our hospital after developing acute onset loss of consciousness and weakness in all four extremities immediately after receiving a CFJI at C2-C3 level. The procedure was done under X-ray guidance and bone was felt upon needle insertion. Syringe was drawn and no blood or CSF was seen. 4 cc of 0.25% Marcaine, 1:200,000 Epinephrine and 40 mg of Depomedrol was given. She was hemodynamically stable but not responding to verbal and noxious stimuli. Brainstem reflexes were present. She was quadriplegic. Reflexes were normal in upper extremities and absent in lower extremities. Plantar responses were mute. CT scan of head showed hydrocephalus. CTA head and neck were normal. MRI of the brain showed T2 hyperintensity of bilateral thalami, cerebellum, occipital and temporal lobes without diffusion restriction suggesting cerebral edema due to encephalitis. Patient continued to get worse and repeat CT scan showed worsening hydrocephalus with herniation. An emergent bedside EVD was placed. Patient clinically continued to worsen with loss of brainstem reflexes and progressed to brain death in next 12 hours.

Conclusions CONCLUSIONS: We hypothesize that if drugs are injected in the cerebral vasculature, they alter the permeability of the blood-brain barrier by causing shrinkage of endothelial cells and enter into the cerebral interstitial tissue leading to direct neurotoxicity. Appropriate precautions and knowledge of rare complications of FJI needs to be considered while managing CH.

Authors/Disclosures
Kashif A. Mir, MD PRESENTER	No disclosure on file
Anand Vaishnav, MD (Vadodara Stroke Center)	No disclosure on file
	No disclosure on file
Kerri S. Remmel, MD, PhD (Regional Brain Institute)	Dr. Remmel has nothing to disclose.
Ludwig Kappos, MD, FAAN (RC2NB, University Hospital Basel)	Dr. Kappos has nothing to disclose.

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