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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Any thoughts about having a spinal stroke with a

Customer Question

Any thoughts about having a spinal stroke with a transforaminal esi. As opposed to arach, that what a doc told me as I said in my original question.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hello. Welcome to JA

Expert:  Dr. Frank replied 1 year ago.

Hello. So you have been given the diagnosis of conus medularis syndrome? Was that noted on the initial MRI that was taken of your Lumbar spine?

Expert:  Dr. Frank replied 1 year ago.

I am aware of spinal strokes happening with cervical esi, where the vertebral artery and or anomalous branches including the anterior segmental medullary artery was damaged, causing an ischemic myelopathy at C6 level or a vertebral basilar stroke. But that was cervical where the entire cord runs in communication to the level injected. In the lumbar spine, I would assume you had the transforaminal at L4/5 and the conus ends at the L1/2 level, you are dealing with the cauda equina, and I don't know how the infarct could ascend by injection of air/steroid into the spinal branches of the posterior intercostal artery. That is my opinion, I do not claim to be an expert in this field. I am trained in steroid epidural injections. There is a entity where severe cauda equine syndrome can evolve into involving the conus medullaris. I don't have your films or any data to review. So that is the best I can do with this answer. Please get back to me to discuss this further if I can help, or rate my service if satisfied. Dr Frank

Expert:  Dr. Frank replied 1 year ago.

I checked the literature. Here is an abstract that discusses this issue. They state there are 5 reported cases. I will attach the abstract. Please get back to me to discuss. Dr Frank

http://www.ncbi.nlm.nih.gov/pubmed/25694868

Expert:  Dr. Frank replied 1 year ago.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300874/

Here is the whole paper. Forget the abstract.

In this case the ESI was done at L5/S1. They followed the progression of the infarction (spinal stroke) with MRI. Very interesting. Dr Frank

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