Clinical question: Assess for epidural hematoma after epidural steroid injection last week. Signs and symptoms: Subjective right leg weakness and increased urinary frequency. Pre- and post enhanced lumbar MRI:Examination demonstrates a posterior epidural collection with mixed T2 and T1 signal intensity along the dorsal aspect of the spinal canal at L4-L5 disc level. It measures approximately 25 mm in cranial cephalad axis and 7 x 12 mm in transaxial dimensions. Finding is highly suspected of a small epidural hemorrhage. It results in subtle mass effect on the thecal sac posteriorly. On prior MRI exam from 3-20 2-15 from St. Alexius Medical Center there is also a central disc protrusion at this level with mass effect on the thecal sac which in combination with the epidural collection results in significant central spinal stenosis at this level. There is no significant neural foraminal compromise.Advanced degenerative disc disease at L4-L5 and moderate bilateral facet and ligamentum flavum hypertrophy is also noted at this level.Examination at L3-L4 demonstrate moderate disc disease, broad base bulging disc and moderate hypertrophic changes of posterior elements with resultant significant central spinal stenosis. There is no significant change of this finding since prior outside institution lumbar MRI. A tiny central disc extrusion at this level is also noted.Moderate disc disease and hypertrophic changes of posterior elements at L5-S1 as well as a small left paramedian disc protrusion without central spinal stenosis or significant neural foraminal compromise is noted. Mild degenerative changes at other levels however without central spinal stenosis.
1.At L4-L5 there is a small posterior epidural hemorrhage which in combination with a large central disc protrusion results in significant central spinal stenosis.2.At L3-L4 extensive degenerative changes also results in significant central spinal stenosis. No change since prior outside institute exam.3.At L5-S1 degenerative changes and including a left paramedian disc protrusion without spinal stenosis is present.