Disclosures: Lyndly J. Tamura, MD: Nothing to disclose

Case Description: The patient underwent a right L5-S1 transforaminal epidural steroid injection under fluoroscopy. Moderate sedation was used due to the significant anxiety prior to the procedure. Isovue contrast dye was injected under live fluoroscopy confirming absence of intra-thecal or intra-vascular flow. 1 mL (10mg/mL) of preservative free dexamethasone was then injected. There were no complications during the procedure. In PACU, she reported right buttock pain and inability to move or feel her right lower extremity. On physical exam, the patient had no movement in the right lower extremity including hip flexion, though full motor strength on the left. She was unable to detect light touch or pain with pinch diffusely on the right, even when tested without her knowledge. She was transferred to the ED and was ultimately admitted to the hospital.

Setting: Outpatient surgery center, ED, hospital.

Patient: 53-year-old female with chronic low back pain and right lower extremity radicular pain secondary to central canal stenosis at L4-L5.

Assessment/Results: She underwent an extensive workup including MRI of the entire spine, CT of the brain, and multiple lab tests. All diagnostic tests were negative. Neurology and Neurosurgery were consulted and reported that there was no organic cause for her symptoms, and ultimately diagnosed her with a functional neurological disorder. She remained in the hospital for 4 days, with strength and sensation improving each day. Her symptoms had improved significantly at the time of discharge.

Discussion: This is the first reported case, to our knowledge, of a functional neurological disorder after a lumbar transforaminal epidural steroid injection.

Conclusion: Due to potential adverse events that can be associated with epidurals, an extensive medical workup is warranted in any patient with new neurological symptoms after an epidural. Functional neurological disorder, or conversion disorder, may be part of the differential, but only after organic causes are ruled out.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/functional-neurological-disorder-after-a-lumbar-transforaminal-epidural-steroid-injection/