CASE PRESENTATION: A 55-year-old woman with chronic myelopathic pain presented to a clinic for a ESI. Pre-injection, she underwent a cervical myelogram to localize the epidural space. After the contrast injection, the patient had acute onset of left-sided chest pain. She was referred to the emergency department, where she complained of worsening pain in the shoulders and numbness in bilateral arms. Her neurologic exam revealed mild weakness of the right arm and paralysis of the left arm; there were absent reflexes and diminished pin prick on the left arm and leg. Cervical CT scan demonstrated dense material in the intramedullary space measuring 0.7x1.0 cm and extending from the cervico-cranial junction to T2-3 disc. A subsequent MRI confirmed these findings and also demonstrated mild cervical and thoracic cord edema. She was admitted to the MICU for monitoring given reported dyspnea; a NIF was normal at -60 cm H2O. She was given dexamethasone 10mg IV every 6 hours with subsequent improvement of her motor symptoms and dyspnea within 24 hours. At the time of hospital discharge she continued to have decreased sensation in her left arm and leg, namely to vibration and temperature. These sensory symptoms continued to persist on her one-month follow-up in clinic.