FISH OIL AS A POTENTIAL CONTRIBUTOR TO EPIDURAL HEMATOMA FOLLOWING CERVICAL EPIDURAL STEROID INJECTION: A CASE REPORT AND FOCUSED LITERATURE REVIEW

Bleeding Complications ◽

Over The Counter ◽

Fish oil has been anecdotally linked to bleeding complications during interventional spinal procedures. We present a case report involving a cervical epidural hematoma following cervical epidural injection in a patient who has been taking fi sh oil, with detailed literature review. A 49-year-old woman with a previous history of anterior cervical disc fusion at C5-C6 underwent routine cervical epidural injection for neck pain due to a disc herniation below her fusion. Thirty minutes after the procedure, she experienced numbness and tingling in both arms and developed severe pain between her shoulder blades. She was sent to the emergency room and soon developed a left-sided wrist drop. An emergent cervical magnetic resonance image (MRI) revealed an epidural hematoma at C6-C7. She underwent emergent surgical decompression of the hematoma through multiple laminectomies at C6, C7, and T1. The surgeon noticed excessive blood oozing through the incision site and left two drains in the wound. She recovered without neurological defi cit. Upon further investigation, it was discovered that she had been taking high doses of over-the-counter fi sh oil. Ingredients in over-the-counter preparations are not regulated or standardized. Fish oil use may predispose a patient to bleeding complications when used in higher doses alone or when used at any dose in conjunction with antiplatelet therapy. The benefi ts of fi sh oil use should be weighed against the potential risk of bleeding with cessation of fi sh oil in patients undergoing spinal interventions. As described by others, signifi cant pain at the site of injection which is unusual and different from the pain experienced in the past as well as complicating factor of loss of resistance technique in closed space must be considered. Finally, rapid diagnosis and intervention avoids neurological defi cit. Key words: Fish oil, omega-3, aspirin, cervical epidural steroid injection, complication, epidural hematoma, literature review

Poster 471 Anticoagulation in New Onset Atrial Fibrillation Directly after Epidural Steroid Injection Causing Epidural Hematoma: A Case Report

PM&R ◽

10.1016/j.pmrj.2014.08.842 ◽

2014 ◽

Vol 6 (9) ◽

pp. S351 ◽

Cited By ~ 1

Author(s):

Parag Shah ◽

D'Wan J. Carpenter ◽

Tad P. DeWald ◽

Steven R. Hinderer

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

Epidural Hematoma ◽

Steroid Injection ◽

Epidural Steroid ◽

Onset Atrial Fibrillation ◽

New Onset

Poster 391 Steroid Psychosis After Cervical Transforaminal Epidural Steroid Injection: A Case Report and Literature Review

PM&R ◽

10.1016/j.pmrj.2012.09.1001 ◽

2012 ◽

Vol 4 ◽

pp. S324-S324

Author(s):

Michelle D. Francavilla ◽

Jose Mena

Keyword(s):

Case Report ◽

Literature Review ◽

Steroid Injection ◽

Transforaminal Epidural Steroid Injection ◽

Poster 264: Is it Safe for Patients to Undergo Epidural Steroid Injections While Taking Non-Steroidal Anti-inflammatory Medications? A Case Report in Which a Patient Developed a Subacute Epidural Hematoma After Lumbar Epidural Steroid Injection

PM&R ◽

10.1016/j.pmrj.2009.08.286 ◽

2009 ◽

Vol 1 ◽

pp. S218-S218

Author(s):

Sanjog Pangarkar ◽

Chris Janssen ◽

Ai Mukai

Keyword(s):

Case Report ◽

Epidural Hematoma ◽

Steroid Injection ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Anti Inflammatory ◽

Poster 380 Spinal Epidural Hematoma Resulting in Tetraplegia After Cervical Interlaminar Epidural Steroid Injection and Intramuscular Ketorolac: A Case Report

PM&R ◽

10.1016/j.pmrj.2012.09.991 ◽

2012 ◽

Vol 4 ◽

pp. S320-S320

Author(s):

George C. Chang Chien ◽

Kenneth D. Candido ◽

Andrew L. Hendrix

Keyword(s):

Case Report ◽

Epidural Hematoma ◽

Steroid Injection ◽

Spinal Epidural Hematoma ◽

Interlaminar Epidural Steroid Injection ◽

Epidural Steroid ◽

Spinal Epidural ◽

Intramuscular Ketorolac

A Rare Case of Thyrotoxic Periodic Paralysis After Epidural Steroid Injection: A Case Report and Literature Review

American Journal of Case Reports ◽

10.12659/ajcr.911270 ◽

2018 ◽

Vol 19 ◽

pp. 1453-1458 ◽

Cited By ~ 1

Author(s):

Kwame Ofori Affram ◽

Tanya Luke Reddy ◽

Kofi M. Osei

Keyword(s):

Case Report ◽

Literature Review ◽

Rare Case ◽

Steroid Injection ◽

Periodic Paralysis ◽

Thyrotoxic Periodic Paralysis ◽

Poster 483 Inflammatory Myelitis with Acute Paraparesis following Epidural Steroid Injection: A Case Report

PM&R ◽

10.1016/j.pmrj.2014.08.852 ◽

2014 ◽

Vol 6 (9) ◽

pp. S355

Author(s):

Julie A. Ferris ◽

Ronald Taylor

Keyword(s):

Case Report ◽

Steroid Injection ◽

Acute Paraparesis ◽

Transient hypercorticism after epidural steroid injection. A case report.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-198466070-00024 ◽

1984 ◽

Vol 66 (7) ◽

pp. 1115-1116 ◽

Cited By ~ 38

Author(s):

J L Stambough ◽

R E Booth ◽

R H Rothman

Keyword(s):

Case Report ◽

Steroid Injection ◽

Cervical epidural hematoma following interlaminar epidural steroid injection via the contralateral oblique view in patient taking omega-3 fatty acids

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000005 ◽

2019 ◽

Vol 44 (2) ◽

pp. 253-255 ◽

Cited By ~ 3

Author(s):

Drew Beasley ◽

Johnathan H. Goree

Keyword(s):

Fatty Acids ◽

Epidural Hematoma ◽

Steroid Injection ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Oblique View ◽

Anti Inflammatory ◽

Interlaminar Epidural Steroid Injection ◽

Background and objectivesWe sought to describe a case of an epidural hematoma after a cervical interlaminar epidural steroid injection (ILESI) performed using contralateral oblique view. We also discuss factors that could have placed this patient at increased risk, including concurrent use of omega-3 fatty acids and non-steroidal anti-inflammatory medications.Case reportA 74-year-old woman returned to the pain clinic, within 15 min of discharge, after an apparent uncomplicated cervical ILESI using the contralateral oblique technique with severe periscapular pain and muscle spasms. Cervical MRI showed a large epidural hematoma which was subsequently emergently evacuated. On postoperative examination, the patient had no neurologic deficits and full resolution of her painful symptoms.ConclusionsTo our knowledge, this is the first reported case of cervical epidural hematoma in which the contralateral oblique technique was used. Also, this is the second case in which the combination of non-steroidal anti-inflammatory medications and omega-3 fatty acids has been considered as a contributor to increased hematoma risk. This case underscores the risk of epidural hematoma using a novel fluoroscopic technique and the need for potential discontinuation of supplements like omega-3 fatty acids.