ABSTRACT
Ten years after placement of a spinal cord stimulator (SCS) and resolution of pain, this patient presented with progressive paraplegia, worsening thoracic radicular pain at the same dermatome level of the electrodes, and bowel and bladder incontinence. Computed tomographic myelogram confirmed thoracic spinal cord central canal stenosis at the level of electrodes. After removal of the fibrotic tissue and electrodes, the patient had resolution of his thoracic radicular pain and a return of his pre-SCS pain and minimal neurologic and functional return. To the authors' knowledge, no studies have been identified with thoracic SCS lead fibrosis in the United States causing permanent paraplegia. Only one other case has been reported in Madrid, Spain. Patients with SCS presenting with loss of pain relief, new-onset radicular or neuropathic pain in same dermatome(s) as SCS electrodes, worsening neuromuscular examination, or new bladder or bowel incontinence need to be evaluated for complications regarding SCS implantation causing spinal stenosis and subsequent cord compression to avoid permanent neurologic deficits.
Subject(s)
Electrodes, Implanted/adverse effects , Failed Back Surgery Syndrome/therapy , Paraplegia/etiology , Spinal Cord Compression/etiology , Spinal Cord Stimulation/adverse effects , Spinal Stenosis/etiology , Humans , Male , Middle Aged , Paraplegia/diagnosis , Paraplegia/surgery , Spinal Cord Compression/diagnosis , Spinal Cord Compression/surgery , Spinal Cord Stimulation/instrumentation , Spinal Stenosis/diagnosis , Spinal Stenosis/surgery , Thoracic Vertebrae , Time FactorsABSTRACT
Spastic hemiplegia is a common sequela of stroke. Spasticity that is not optimally reduced with systemic therapy is often treated with intramuscular botulinum toxin injections. Spastic tone can increase the difficulty of appropriately positioning the patient for botulinum toxin injections, lengthen procedure duration, and increase periprocedural pain. Our patient, a 53-year-old woman, was unable to be adequately positioned to receive botulinum toxin injections to her left upper extremity because of challenging flexion synergy posturing and related positional pain. A left interscalene brachial plexus local anesthetic block administered under ultrasound guidance was used to produce both temporary dense muscle relaxation and profound anesthesia, facilitating successful and comfortable botulinum toxin injections in this patient.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Brachial Plexus Block , Hemiplegia/complications , Muscle Spasticity/therapy , Neuromuscular Agents/therapeutic use , Stroke/complications , Female , Humans , Middle Aged , Muscle Spasticity/etiologyABSTRACT
BACKGROUND: although peripheral intravenous catheter (PIV) infiltration is a frequent hospital occurrence, muscle rupture is a previously unknown complication of line infiltration. We present the case of a 21-year-old male with a history of cystic fibrosis, bilateral lung transplant, and chronic corticosteroid use, with longitudinal tear of the biceps brachii muscle as a complication of PIV infiltration. METHODS: case report describing a unique case of a longitudinal tear of the biceps brachii. RESULTS: magnetic resonance imaging revealed longitudinal tear of the biceps brachii with sparing of the proximal and distal tendons. Nerve conduction studies and electromyography revealed bicipital denervation, most likely due to mechanical compression. CONCLUSION: we hypothesize that the patient's chronic corticosteroid use predisposed him to muscle injury, as did basilic vein thrombosis caused by PIV infiltration, and this combination of factors led to bicipital rupture. To our knowledge, this is also the first case report to document longitudinal tear of the biceps brachii with sparing of the distal and proximal tendinous insertions of the muscle.
