Canadian Journal of Anaesthesia

, Volume 43, Issue 5, pp 471–474 | Cite as

Bacterial meningitis and cauda equina syndrome after epidural steroid injections

Clinical Reports

Abstract

Purpose

To describe a rare adverse outcome resulting from lumbar epidural steroid injections for the treatment of chronic lower back pain.

Clinical features

We report a case of staphylococcus aureus meningitis and cauda equina syndrome following a series of epidural steroid injections for chronic back pain. Although rare, bacterial meningitis following epidural analgesia has been reported, but epidural steroid injections have not been associated with either bacterial meningitis or cauda equina syndrome. The causal relationship between epidural steroid injections, bacterial meningitis, and cauda equina syndrome is discussed.

Conclusion

A thorough pre-procedure assessment with attention to the neurologic examination and signs/symptoms of infection is essential.

Key words

anaesthetic techniques: epidural complications: bacterial meningitis, cauda equina syndrome 

Résumé

Objectif

Décrire une complication rare survenue à la suite d’injections épidurales lombaires de stéroïdes pour le traitement d’une lombalgie chronique.

Caractéristiques cliniques

Une méningite à staphylocoque doré accompagnée d’un syndrome de la queue de cheval est apparue à ta suite d’une série d’injections épidurales de stéroïdes administrées pour traiter une lombalgie chronique. Quoique rare, la méningite bactérienne a déjà été rapporté à la suite d’une épidurale mais les stéroïdes épiduraux n’ont jamais été associés à une méningite bactérienne et au syndrome de la queue de cheval. La relation causale entre les injections épidurales de stéroïdes, la méningite bactérienne et le syndrome de la queue de cheval est discutée.

Conclusion

Avant de réaliser la technique épidurale, il est essentiel de procéder à un examen neurologique et de rechercher les signes et les symptômes d’une infection.

References

  1. 1.
    Cousins MJ, Bridenbaugh PO. Complications of epidural blockade,In: Neural Blockade in Clinical Anesthesia and Management of Pain, 2nd ed. Philadelphia: JB Lippincott Company, 1988: 340.Google Scholar
  2. 2.
    Bromage PR. Spinal extradural abscess: pursuit of vigilance. Br J Anaesth 1993; 70: 471–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Jensen AG, Espersen F, Skinhoj P, Rosdahl VT, Frimodt-Moller N. Staphylococcus aureus meningitis. A review of 104 nationwide, consecutive cases. Arch Intern Med 1993; 153: 1902–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Ready LB, Helfer D. Bacterial meningitis in parturients after epidural anesthesia. Anesthesiology 1989; 71: 988–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Ania BJ. Staphylococcus aureus meningitis after short-term epidural analgesia. Clin Infect Dis 1994; 18: 844–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Quagliarello V, Scheld WM. Bacterial meningitis: pathogenesis, pathophysiology, and progress. N Engl J Med 1992; 327: 864–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Domingo P, Mancebo J, Blanch L, Coll P, Martinez E. Iatrogenic streptococcal meningitis (Letter). Clin Infect Dis 1994; 19: 356–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Harding SA, Collis RE, Morgan BM. Meningitis after combined spinal-extradural anaesthesia in obstetrics. Br J Anaesth 1994; 73: 545–7.PubMedCrossRefGoogle Scholar
  9. 9.
    de Leon-Casasola OA, Myers DP, Rempel J, et al. A prospective analysis of epidural migration in 1598 surgical cancer patients. Anesthesiology 1991; 75: A730.CrossRefGoogle Scholar
  10. 10.
    Gilman AG, Rall TW, Nies AS, Taylor P. Adrenocortical steroids,In: Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 8th ed. Toronto: Pergamon Press, 1990: 1443–5.Google Scholar
  11. 11.
    Elliott RH, Collett BJ. Delayed septicaemia after extradural steroid treatment (Letter). Br J Anaesth 1992; 69: 422–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Goucke CR, Graziotti P. Extradural abscess following local anaesthetic and steroid injection for chronic low back pain. Br J Anaesth 1990; 65: 427–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Rigler ML, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 1991; 72: 275–81.PubMedCrossRefGoogle Scholar
  14. 14.
    Cheng AC. Intended epidural anesthesia as possible cause of cauda equina syndrome. Anesth Analg 1994; 78: 157–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Drasner K, Rigler ML, Sessler DI, Stoller ML. Cauda equina syndrome following intended epidural anesthesia. Anesthesiology 1992: 77; 582–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Ackerman WE III, Andrews PJ, Juneja MM, Rigor BM. Cauda equina syndrome: a consequence of lumbar disk protrusion or continuous subarachnoid analgesia? Anesth Analg 1993; 76: 898–901.PubMedCrossRefGoogle Scholar
  17. 17.
    Bainton CR, Strichartz GR. Concentration dependence of lidocaine-induced irreversible conduction loss in frog nerve. Anesthesiology 1994; 81: 657–67.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  1. 1.Department of AnaesthesiaUniversity Hospital and Program in Critical Care Medicine, University of Western OntarioLondon

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