2016, Number 4
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Rev Mex Neuroci 2016; 17 (4)
Is it safe the intrathecal gadolinium administration? A new case of encephalopathy after performing a MRI-cisternography
Belli MHR, Cauich EE, Cih OGA, Ruiz GJ, Jiménez BMV
Language: Spanish
References: 21
Page: 125-132
PDF size: 566.27 Kb.
ABSTRACT
Introduction: Gadolinium (Gd) is used as an intravenous contrast
material on magnetic resonance imaging (MRI). Its intrathecal use
for techniques such as MR-myelography/cisternography is relatively
safe, with very occasional and usually mild neurological side effects.
There are described serious neurological complications just after
accidental administration of high doses of intrathecal Gd.
Case report: A 53-year-old female showed symptoms
compatible with cerebrospinal fluid (CSF) leak after performing
MR-cisternography. A 1 ml of gadobutrol (Gd 1 mmol) was injected
in the subarachnoid space guided by fluoroscopy. After 5 hours
of observation she presented with headache, fluctuating global
aphasia with subsequent deterioration of consciousness and
generalized tonic-clonic seizure. Urgent head CT evidenced a diffuse
hyperdensity distributed in the subarachnoid space and bubbles
of pneumoencephalus in subarachnoid and intraventricular space.
The lumbar puncture (LP) ruled out a subarachnoid hemorrhage
and infectious meningitis. Antiepileptic drugs and intravenous
steroids were prescribed, with resolution within 24 hours, with the
exception of transient anterograde amnesia. She was diagnosed with
encephalopathy due to intrathecal gadolinium.
Conclusion: Although the safety of intravenous administration
of Gd, its intrathecal use can cause potentially serious neurological
complications, even at low doses. Fortunately, they are rare and
usually transient.
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