Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Neurological Rehabilitation

Acute Ischemic Stroke after Transforaminal Epidural Steroid Injection: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Jonathan Paul, MD

    Resident Physician
    University of Miami/Jackson Health System PM&R Program
    Miami, Florida

  • Ryan P. MacDonald, Other

    Medical Student
    University of Miami Miller School of Medicine
    Miami, Florida

    • Co-Author(s)

  • Sony Issac, MD

    Assistant Professor of Clinical
    University of Miami Leonard M Miller School of Medicine Department of PM&R, Florida

Disclosure(s):
Sony Issac, MD: No financial relationships to disclose
Case Diagnosis: Acute Ischemic Stroke after Transforaminal Epidural Steroid Injection: A Case Report

Case Description or Program Description: 77 year old male with a history of a prior stroke on clopidogrel monotherapy who presents following a subsequent ischemic stroke after transforaminal epidural steroid injection (TFESI) within 6 months of prior infarct.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: The patient’s altered mental status and lower extremity weakness initially improved with implementation of physical, occupational, and speech therapy, however emotional lability hindered his progress. The patient and family refused medication assistance to assist his anxiety and emotional lability and the family ultimately opted to leave against medical advice.

Discussion (relevance): This case highlights the importance of a thorough risk benefit analysis while pursuing elective procedures in patients of high thrombotic risk. The most recent 2020 guidelines for the Society for Neuroscience in Anesthesiology posit that elective intervention should be deferred a minimum of 9 months post-stroke. It is important to note that epidural hematoma remains a notable risk when pursuing TFESI in those on antithrombotic agents, however, there is no consensus on the exact timing of holding antithrombotics in those with recent stroke. It is purported that neurology and cardiology guidance is standard of care. Bridging therapy with a short acting agent as an alternative to long acting therapeutic dosing remains as a potential opportunity to eliminate prolonged drug-holiday which increases the risk of thrombosis and should be considered in patients who are at high thrombotic risk.

Conclusions: Current guidelines suggest waiting a minimum of 9 months prior to pursuing elective TFESI and consult with their neurologist and cardiologist prior to withholding antithrombotic medications due to their high thrombotic risk.