ABSTRACT
INTRODUCTION: Cervical epidural corticosteroid injections are frequently used for the treatment of subacute cervicobrachial pain. This therapy is considered safe, with the vast majority of the complications being minor and transient. CASE REPORT: We present a case of a woman in her fifties who suffered from cervicobrachialgia and received 2 cervical epidural corticosteroid infiltrations. On day 3 after the second infiltration, a new headache appeared and on day 16 a bilateral subdural hematoma was visualized on CT scan. Complete resorption of the hematoma was seen on day 25 without surgical intervention. DISCUSSION: Up until now, only 1 case report of an intracranial subdural hematoma after a cervical epidural steroid injection has been published. But several cases of an intracranial subdural hematoma after spinal, epidural, or combined spinal and epidural anesthesia have been reported. Physicians should be aware of this potentially dramatic complication since post-dural puncture headache after any type of procedure can evolve into a subdural hematoma. Clinical differentiation between the two can be difficult; post-dural puncture headache is characterized by relief of symptoms in the supine position and photophobia/phonophobia. A subdural hematoma should be considered if the headache changes in character, does not respond to treatment, or there are neurological signs such as nausea/vomiting and blurred vision. Immediate medical imaging should then be performed.
Subject(s)
Hematoma, Subdural, Acute/etiology , Hematoma, Subdural, Acute/therapy , Post-Dural Puncture Headache/complications , Post-Dural Puncture Headache/therapy , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Analgesia, Epidural , Back Pain/complications , Back Pain/drug therapy , Conservative Treatment , Female , Headache/etiology , Hematoma, Subdural, Acute/diagnostic imaging , Humans , Magnetic Resonance Imaging , Middle Aged , Post-Dural Puncture Headache/diagnostic imaging , Remission, Spontaneous , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We describe a case of voluntary self-injection with Large Animal Immobilon, a veterinary anaesthesia product containing etorphine, a very strong opioid, and acepromazine, a phenothiazine. This resulted in cardiorespiratory arrest and the need for sustained haemodynamic support after resuscitation. Large Animal Immobilon is used under specific conditions only, mainly in zoo and wildlife medicine. Primary toxicological analysis, although guided by the presumed toxin, could only detect a metabolite of acepromazine in the urine. Further analysis was able to show some traces of etorphine. A number of topics are treated, including the apparent potency of the etorphine and the selection of a suitable antidote, taking into account the different properties of the respective agents.
