Depo- Medrol®R (Pfizer, New York, NY) is a high-potency steroid with high glucocorticoid effects and low mineralocorticoid effects. The preparation when injected provides for a slow release of the active steroid to the target site. Controversy occurred over its use in epidu-ral steroid injections with respect to the occurrence of arrachnoiditis and other neurologic injuries when it was accidentally injected intrathecally (Bernat et al. 1976). However, there are other studies of deliberate intrathecal injection of Depo- Medrol®R without neurotoxicity (Kotani et al. 2000).
What is clear however is that there is a potential for intravascular injection with the use of any particulate steroid which can lead to arteriole occlusion and stroke. Cervical trans-foraminal epidural steroid injections, for example, are now discouraged (Rathmell et al. 2000, Cousins 2000).
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