Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study.

To The Editor: We commend Dr. Okubadejo and colleagues for the article “Perils of Intravascular Methylprednisolone Injection into the Vertebral Artery. An Animal Study” (2008;90:1932-8). They show a convincing association between intra-arterial injection of particulate steroid and catastrophic neurological injury. This study should help to eliminate remaining questions about the mechanism of injury. We offer a caution about judging the permanency of neural injury and issue a call for further study of the safety and effectiveness of nonparticulate steroids, particularly dexamethasone. In practice, patients are given days or longer to recover from neurological insult before …