• PM R · May 2018

    Case Reports

    Transient Hypokalemic Quadriplegia After a Lumbar Transforaminal Epidural Dexamethasone Injection: A Case Report.

    • Maryam Tahmasbi Sohi, William J Sullivan, and Dustin J M Anderson.
    • Physical Medicine & Rehabilitation Service, VA Eastern Colorado Health Care System, 1055 Clermont Street (117), Denver, CO 80220; Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine, Aurora, CO.
    • PM R. 2018 May 1; 10 (5): 544-547.

    AbstractA 30-year-old man with no significant medical history presented with hypokalemic quadriplegia 4 hours after he received a lumbar transforaminal epidural steroid injection (ESI) containing dexamethasone and lidocaine. A comprehensive workup ruled out acquired and hereditary causes of hypokalemic paralysis. Symptoms gradually resolved within hours after potassium restoration with no residual neurologic deficits. Paralysis after transforaminal ESI is uncommon but has been associated with particulate steroids that can coalesce into aggregates and occlude vessels. To our knowledge, there have been no case reports of paralysis after ESI with dexamethasone, a nonparticulate steroid. This transient paralysis is possibly caused by the effects of glucocorticoids on Na-K channels and insulin resistance resulting in hyperglycemia and subsequent hypokalemia. We reviewed the differential diagnosis of transient paralysis after epidural steroid injection in this report.Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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