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Academia Mexicana de Neurología, A.C.

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.


REFERENCES

  1. Maramattom BV, Manno EM, Wijdicks EF, Lindell EP. Gadolinium encephalopaty in a patient with renal failure. Neurology 2005;64:1276-8

  2. Tali ET, Ercan N, Krumina G, Rudwan M, Mironov A, Zeng QY, et al. Intratecal gadolinium (gadopentate dimeglumine) enhanced magnetic resonance myelography and cisternography: results of a multicenter study. Invest Radiol 2002;37:152-9

  3. Niendorf HP, Haustein J, Cornelius I, Alhassan A, Clauss W. Safety of gadolinium-DTPA: extended clinical experience. Magn Reson Med 1991; 22: 222-8

  4. Park KW, Im SB, Kim BT, Hwang SC, Park JS and Shin WH. Neurotoxic manifestation of an overdosage intratecal injection of gadopentate dimeglumine. J Korean Med Sci 2010; 25:505-8

  5. Algin O, Turkbey B. Intrathecal gadolinium-enhanced MR cisternography: a comprhensive review. AJNR. Am J Nuroradiol 2013;34:14-22

  6. Papadopoulou A, Ahlhelm FJ, Lilmer S, Kappos L, Sprenger T. Detection of cerebrospinal fluid leaks by intratecal contrast-enhanced magnetic resonance myelography. JAMA Neurol.2013;70(12):1576-1577

  7. Parissis D, Ioannidis P, Karacostas D. Intrathecal gadolinium for magnetic resonance myelography in spontaneous intracranial hypotension: valuable but may be risky. JAMA Neurol 2014; 70(6):802

  8. Jinkins et al. Intrathecal gadolinium-enhanced MR cisternography in the evalutation of clinically suspected cerebrospinal fluid rhinorrhea in humans: early experience. Radiology 2002; 222: 555- 559.

  9. Akbar JJ et al. The Role of MR Myelography with intrathecal Gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiolol 2012; 33: 535-540

  10. Di Chiro G, Knop RH, Girton ME, Dwyer AJ, Doppman JL, Patronas NJ et al. MR cisternography and myelografy with Gd-DTPA in monkeys. Radiology 1985;157:373-7

  11. Ray DE, Cavanagh JB, Nolan CC, et al. Neurotoxic effect of gadopentate dimeglumine: behavioral disturbance and morphology after intracerebroventricular injection in rats. AJNR. Am J Neuroradiol 1996;17:365-71

  12. Skalpe IO, Tang GJ. Magnetic resonance imaging contrast media in the subarachnoid space: a comparison between gadodiamide injection an gadopentetate dimeglumine in an experimental study in pigs. Invest Radiol 1997;32:140-8

  13. Albayram S, Kilic F, Ozer H, et al. Gadolinium-enhanced RM cisternography to evaluate dural leaks in intracranial hypotension syndrome. AJNR Am J Neuroradiol 2008;29:116-21

  14. Yoo HM, Kim SJ, Choi CG, et al. Detection of CSF leak in spinal CSF leak syndrome using MR myelography: correlation with radioisotope cisternography. AJNR Am J Neuroradiol 2008: 29:649- 54

  15. Selcuk H, Albayram S, Ozer H, et al. Intratecal gadolinium-enhanced RM cisternography in the evaluation of CSF leakage. AJNR. Am J Neuroradiol 2010;31:71-75

  16. Zeng Q, Xiong L, Jinkins JR, et al. Intrathecal gadolinium-enhanced MR myelography and cisternography: a pilot study in human patients. AJR Am J Roentgenol 1999;173:1109-15

  17. Shellock FG, Kanal E. Safety of magnetic resonance imaging contrast agents. J Magn Reson Imaging 1999;10:477-484

  18. Li L, Gao FQ, Zhang B, Luo BN, Yang ZY, Zhao J. Overdosage of intratecal gadolinium and neurological response. Clinical radiology (2008) 63: 1063-1068

  19. Kapoor R, Liu J, Devasenapathy A, Gordin V. gadolinium encephalopathy after intratecal gadolinium injection. Pain Physician 2010;13:E321-E362

  20. Arit S, Cepek L, Rustenbeck HH, Prange H, Reimers CD. Gadolinium encephalopathy due to accidental intratecal admnistation of gadopentate dimeglumine. J Neurology 2007, 254: 810-812

  21. Samarctzic D, Thamburaj K. Magnetic Resonance Characteristics and Suceptibility Weighted Imaging of the Brain in Gadolinium Encephalopathy. J Neuroimaging 2015;1:36-39




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