819 - Paraplegia Following MRI in a Patient with Spinal Cord Stimulator: A Case Report

Case Diagnosis: Iatrogenic Paraplegia

Case Description: A 53-year-old man with a spinal cord stimulator developed paraplegia following magnetic resonance imaging (MRI). The patient has a history of lower back pain and multiple spinal surgeries with an implanted spinal cord stimulator. He suffered a work injury six years ago to his left shoulder and was scheduled for an MRI. While in the scanner, he felt an acute "searing hot" pain in the thoracic spine. Afterwards, he reported shooting dysesthesias into his legs and wrapping dysesthesias around his abdomen. It was found that the spinal cord stimulator was incompatible with MRI. He underwent a laminectomy and removal of the stimulator but experienced progressive neurological decline.

Discussions: Thermal injury from MRI has been reported in the literature and is recognized as a potential complication for patients with spinal cord stimulators undergoing MRI. This particular case is unique due to the progressive development of complete paraplegia following the MRI procedure. Despite thorough diagnostic investigations performed over subsequent follow-ups, a definitive pathological finding in the spinal cord could not be determined. Nevertheless, the temporal relationship between the incident and the onset of symptoms strongly supports the likelihood of an MRI-induced thermal burn injury which occurred during an MRI procedure.

Conclusions: This unique case highlights the unexpected neuromuscular consequences that can arise due to MRI-induced thermal injury in patients with spinal cord stimulators. Physiatrists and clinicians should maintain a high degree of suspicion when evaluating complex cases involving paraplegia and spinal cord injury.