Epidural hematoma with Brown-Sequard syndrome caused by an epidural injection is a rarely found condition in the emergency department (ED). We report an unusual case of Brown-Sequard syndrome in a 55-year-old man who presented at the ED with right-sided weakness and contralateral loss of pain and temperature sensation after a cervical epidural injection for shoulder pain. Cervicla spine magnetic resonance imaging showed an epidural hematoma from C4 to C6. After admission, his right hemiparesis and contralateral sensory loss improved within eight days, and surgical decompression was not required. Diagnosing spinal lesions in the ED is challenging, especially in patients with acute neurological signs requiring immediate evaluation for stroke. In this case, definite hemiparesis and some contralateral sensory loss were noted. Therefore, a potential spinal lesion was suspected rather than a stroke. This case emphasized the importance of conducting a focused neurological examination after history taking.
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2. Cervical radicular pain Laurens Peene, Steven P. Cohen, Brigitte Brouwer, Rathmell James, Andre Wolff, Koen Van Boxem, Jan Van Zundert Pain Practice.2023; 23(7): 800. CrossRef
Postoperative Brown–Séquard syndrome complicated by spinal epidural haematoma after cervical laminoplasty: A case report and literature review Kai-Chieh Chang, Cheng-Ta Hsieh Interdisciplinary Neurosurgery.2023; 33: 101783. CrossRef
Descending necrotizing mediastinitis (DNM) is a rare form of mediastinal infection. Most cases are associated with esophageal rupture. DNM after a trigger point injection in the upper trapezius has not been described previously. We present a case of DNM after a trigger point injection in the upper trapezius. A 70-year-old man visited the emergency department with chest discomfort and fever after a trigger point injection in the left upper trapezius. Chest computed tomography showed evidence of DNM, and antibiotic therapy was immediately administered intravenously. Because of the risk of sudden death, poor prognosis due to underlying disease, and his age, he declined surgical treatment and died of septic shock. Although trigger point injections are generally considered safe, caution should be used in patients with an underlying disease or in the elderly. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical management are essential to improve the prognosis.
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ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine David Anthony Provenzano, Michael Hanes, Christine Hunt, Honorio T Benzon, Jay S Grider, Kelly Cawcutt, Tina L Doshi, Salim Hayek, Bryan Hoelzer, Rebecca L Johnson, Hari Kalagara, Sandra Kopp, Randy W Loftus, Alan James Robert Macfarlane, Ameet S Nagpal, Regional Anesthesia & Pain Medicine.2025; : rapm-2024-105651. CrossRef
Ultrasound‐Guided Trigger Point Injections for the Treatment of Neck and Back Pain in the Emergency Department Robert A. Farrow, Mark Newberry, Tony Zitek, Jackie Farrow, Oren J. Mechanic, Michael Rosselli Journal of Ultrasound in Medicine.2023; 42(5): 1023. CrossRef
Bilateral supraclavicular abscesses following trigger point injections Frank J. Salamone, Karthik Kanamalla, Swachchhanda Songmen, Joshua Sapire Radiology Case Reports.2021; 16(9): 2630. CrossRef
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