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24th Annual Pain Medicine Meeting 2025
November 13-15, 2025| JW Marriott Austin, Austin, Texas
2192864
Paralyzed by Relief: A Rare Case of Transient Quadriplegia Following Cervical Epidural Injection
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Medically Challenging Cases
Paralyzed by Relief: A Rare Case of Transient Quadriplegia Following Cervical Epidural Injection
•Cervical epidural steroid injections (CESI) are commonly utilized for managing neck pain related to cervical degenerative conditions, (1)
•The intended goal is to decrease inflammation and reduce pressure on the spinal cord and exiting nerve roots.
•41% experience greater than 90% pain relief initially and 29% of patient with >50% relief at 6 months.
•Considered safe with over 200,000 performed annually in the US.
•Only 4 documented cases of paralysis from the rare complication of intramedullary spinal cord injection ( 3-5).
•Intralaminar and transforaminal are the most common approaches
Case Presentation
•Patient: 45-year-old female
•Relevant Medical History:
•Hypertension, morbid obesity, migraines, myofascial pain syndrome, fibromyalgia
•Cervical spinal stenosis with radiculopathy confirmed by EMG and prior ACDF (C5–C6) and posterior discectomy (C6–C7)
•Remote CVA at age 15 (thrombotic, no residual deficits)
•Psychiatric History:
•Acute grief after death of son → panic attacks and insomnia
•Medications: trazodone, lorazepam, buspirone
•Prior Workup:
•Hospitalized for visual changes; lumbar puncture (r/o MS) → post-dural puncture headache treated with blood patch
•Presentation:
•Persistent cervical radiculopathy with bilateral forearm burning pain and left-hand weakness
•Prior treatments (gabapentin, ibuprofen, trigger point injections) minimally effective
•Four prior CESIs provided significant improvement
•Current Procedure:
•CESI at C7–T1 under fluoroscopic guidance using loss-of-resistance with saline correct placement confirmed via contrast epidurogram (no vascular washout)Injected 15 mg dexamethasone in 4 mL solution (Figure 1)
•Immediate Complication:
•Sudden quadriplegia with intact sensation, no bowel/bladder involvement
•Patient remained alert, oriented, hemodynamically stable, no respiratory distress
•Transferred to ED for evaluation
•Hospital Course:
•Motor function returned within one hour, first on the left, then right side leading to full recovery without residual deficits
•Labs: unremarkable; ABG showed respiratory alkalosis
•Declined brain MRI; discharged home
•Follow-Up:
•1 week: increased cervical pain → imaging (CT head, cervical spine, CTA) normal, improved with ketorolac and Medrol dose pack
•1 month: MRI cervical spine unchanged from 1 year prior → no structural injury detected (Figure 2)
Discussion
•Initial differential for immediate loss of motor activity during CESI is mechanical trauma, medication reaction, or vascular injection/injury
•A negative epidurogram and prior CESI with no documented reaction make these causes unlikely but must be evaluated and excluded.
•Functional Neurological Symptom Disorder (FNSD), formerly known as conversion disorder frequently demonstrates paralysis, weakness, or sensory loss (6).
•Symptoms are typically incongruent with pattern of anatomical pattern of injury as in loss of purely voluntary motor function from a posterior approach
•Often seen in settings of stress or pain and can be self resolving (7).