Complex imaging features of accidental cerebral intraventricular gadolinium administration

Abstract

Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) is a contrast agent commonly used for enhancing MRI. In this paper, the authors report on 2 cases of postoperative inadvertent administration of Gd-DTPA directly into a ventriculostomy tubing side port that was mistaken for intravenous tubing. Both cases demonstrated a low signal on MRI throughout the ventricular system and dependent portions of the subarachnoid spaces, which was originally believed to be CSF with areas of T1 shortening in the nondependent portions of the subarachnoid spaces, and misinterpreted as basal leptomeningeal enhancement and meningitis. The authors propose that the appearance of profound T1 hypointensity within the ventricles and diffuse susceptibility artifact along the ependyma is pathognomonic of intraventricular Gd-DTPA and should be recognized.

Fatal gadolinium-induced encephalopathy following accidental intrathecal administration: a case report and a comprehensive evidence-based review

“…To our knowledge, we report the first case report documenting a death following acute GBCA neurotoxicity 16. In this case, the presence of intrathecal gadolinium confirmed by radiographic imaging suggests that the intrathecal space was inadvertently entered when performing the epidurogram for the MILD.…”

The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions

“…51 Finally, a patient required 2 months in an intensive care unit after 10-mL gadopentetate was injected into the side port of a ventriculostomy catheter. 52 Gadolinium has been shown to accumulate in the cerebrospinal fluid (CSF) after intravenous injection in humans. 53,54 In a prospective observational cohort study performed in 82 patients with normal renal function and an intact blood brain barrier (68 had gadobutrol, 14 patients had lumbar puncture without MRI), 9 mL (range, 7-10 mL) of gadolinium was injected in adults and 4 mL (2.6-6.5 mL) in pediatric patients.…”

“…51 Finally, a patient required 2 months in an intensive care unit after 10-mL gadopentetate was injected into the side port of a ventriculostomy catheter. 52…”

Neuraxial and peripheral misconnection events leading to wrong-route medication errors: a comprehensive literature review

“…19 67-92 Less frequently, the misconnection error was the unintentional administration of a peripheral nerve block via the intravenous route (13.1%, 17/130). Two instances each have been described of injecting intravenous drugs into an intraventricular line 13 or into an extraventricular drain. 16 93 Least common were topical or intravascular medications administered by the intrathecal route, with one case each (0.77%).…”

“…4 Misconnections leading to wrong-route medication delivery have been reported across a number of medical specialties, including anesthesiology, emergency medicine, obstetrics, and oncology. [6][7][8][9] These events have occurred in a variety of settings, including inpatient surgery, [10][11][12][13][14] labor and delivery, 6 15 and intensive care units. 16 17 Because of a lack of organized and publicly available reporting, it is not possible to assess the rate of misconnections wherein the denominator is the total number of catheter-based neuraxial and peripheral procedures.…”