Palazón-Cabanes B, Martínez-García FA, Martínez-Lerma EJ, Hernández-Abenza J, Meca-Lallana JE, Martín-Fernández J

Language: Spanish
References: 21
Page: 91-97
PDF size: 308.31 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 exist serious neurological complications reported in literature after accidental administration of high doses of intrathecal Gd.
Case report: We present the case of a 53-yearold female who received an MR-cisternography on suspicion of cerebrospinal fluid (CSF) leakage. One ml of gadobutrol (Gd 1 mmol) was injected in the subarachnoid space guided by fluoroscopy. After 5 h of observation she presented with headache, fluctuating global aphasia with subsequent deterioration of consciousness and generalized tonic-clonic seizures. Urgent cranial CT evidenced diffuse hyperdensity into the subarachnoid space and bubbles compatible with pneumoencephalus in the subarachnoid and intraventricular spaces. The lumbar puncture (LP) ruled out a subarachnoid hemorrhage and infectious meningitis. Antiepileptic drugs and intravenous steroids were prescribed, with resolution within 24 h, except for transient anterograde amnesia. She was diagnosed with encephalopathy due to the administration of intrathecal gadolinium.
Conclusion: Despite the safety of intravenous administration of Gd, intrathecal Gd use can cause potentially serious neurological complications, even at low doses. These complications are considered rare and usually transient.

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