Gadolinium encephalopathy due to accidental intrathecal administration of gadopentetate dimeglumine

Arlt, Sönke; Cepek, Lukas; Rustenbeck, Hans-Heino; Prange, Hilmar; Reimers, Carl D.

doi:10.1007/s00415-006-0439-x

Cited by 50 publications

(32 citation statements)

References 8 publications

(6 reference statements)

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“…†Calculated using 1400 g as the average weight of the human brain in order to be consistent with calculations from Arlt et al 17 …”

Section: Discussion and Review Of The Literaturementioning

confidence: 97%

“…Calculated using 1400 g as the average weight of the human brain in order to be consistent with calculations from Arlt et al 17 †Intrathecal administration was unintentional.‡Unintentional intrathecal administration was due to drug error.GBCA, gadolinium-based contrast agent.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 97%

“…C: Mixed with iohexol. D: Mixed with caldiamide.Note: Only included publications that provided sufficient information to calculate concentration in µmol gadolinium per gram of brain.*Complications were lethal.†Calculated using 1400 g as the average weight of the human brain in order to be consistent with calculations from Arlt et al 17 ‡Delivered over 28 hours.§Delivered over 112 hours.GBCA, gadolinium-based contrast agent.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

See 2 more Smart Citations

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

Provenzano

Pellis²,

DeRiggi

2019

Reg Anesth Pain Med

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Gadolinium-based contrast agents (GBCAs) have been suggested as off-label alternatives to iodine-based contrast agents for fluoroscopic imaging during interventional pain procedures. We report a case of accidental intrathecal administration of a GBCA during a neuraxial interventional pain procedure leading to acute gadolinium neurotoxicity, which resulted in encephalopathy and ultimately death. To our knowledge, it is the first published case of fatal intrathecal gadolinium-induced encephalopathy and the first published case of intrathecal gadoteridol causing serious neurologic complications. In addition, the case presented here is placed in context with an associated comprehensive, evidence-based review of the use of gadolinium in interventional pain procedures, addressing gadolinium chemistry and pharmacologic properties, neurotoxicity and radiology. Physicians must be aware that gadolinium poses a significant risk of acute neurotoxicity even in small doses. Until further safety research is performed, GBCAs should not be considered a safe alternative for use in neuraxial interventional spine procedures when there is a risk of inadvertent intrathecal administration.

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“…†Calculated using 1400 g as the average weight of the human brain in order to be consistent with calculations from Arlt et al 17 …”

Section: Discussion and Review Of The Literaturementioning

confidence: 97%

Section: Discussion and Review Of The Literaturementioning

confidence: 97%

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

See 1 more Smart Citation

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

Provenzano

Pellis²,

DeRiggi

2019

Reg Anesth Pain Med

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“…In two published cases, the high-dose administration of GD produced a fluctuating level of consciousness and neurological deficits (1, 10). In one case, the total gadolinium dose administered intravenously over 7 days was 60-80 mL (1).…”

Section: Discussionmentioning

confidence: 99%

Neurotoxic Manifestations of an Overdose Intrathecal Injection of Gadopentetate Dimeglumine

Park

Kim

et al. 2010

J Korean Med Sci

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The intravenous administration of gadopentetate dimeglumine (GD) is relatively safe and rarely causes systemic toxicity in the course of routine imaging studies. However, the general safety of intrathecal GD has not been established. We report a very rare case of an overdose intrathecal GD injection presenting with neurotoxic manifestations, including a decreased level of consciousness, global aphasia, rigidity, and visual disturbance.

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“…[34][35][36] In 2 previous reports, the behavioral and neurologic alterations were observed only after the intraventricular injection of relatively high doses of Gd; no such behavioral or morphologic changes were observed in the same studies when the total dose was limited to Ͻ3.3 mol/g brain in 15 L. 37,38 However, several recent studies reported intrathecal Gd-induced encephalopathy in humans after the accidental intrathecal injection of a high dose of Gd. 39,40 In these cases, the patients developed severe neurologic symptoms, such as dysarthria, blurred vision, nystagmus, ataxia, and somnolence, followed by behavioral disturbances and psychotic symptoms.…”

Section: 12mentioning

confidence: 99%

Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage

Selçuk¹,

Albayram²,

Özer³

et al. 2009

AJNR Am J Neuroradiol

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BACKROUND AND PURPOSE:Radiologic identification of the location of the CSF leakage is important for proper surgical planning and increases the chance of dural repair. This article describes our experience in analyzing clinically suspected cranial CSF fistulas by using MR imaging combined with the intrathecal administration of a gadolinium-based contrast agent. MATERIALS AND METHODS:A total of 85 consecutive patients with suspected CSF fistulas who presented with persistent or intermittent rhinorrhea or otorrhea lasting for more than 1 month between 2003 and 2007 were included in this study. RESULTS:We observed objective CSF leakage in 64 of 85 patients (75%). The CSF leak was located in the ethmoidal region in 37 patients (58%), in the superior wall of the sphenoid sinus in 8 patients (13%), in the posterior wall of the frontal sinus in 10 patients (15%), in the superior wall of the mastoid air cells in 6 patients (9%), and from the skull base into the infratemporal fossa in 1 patient (2%). Two patients (3%) showed leakage into Ͼ1 paranasal sinus.CONCLUSIONS: MR cisternography after the intrathecal administration of gadopentate dimeglumine represents an effective and minimally invasive method for evaluating suspected CSF fistulas along the skull base. It provides multiplanar capabilities without risk of radiation exposure and is an excellent approach to depict the anatomy of CSF spaces and CSF fistulas. CSF leakage implies abnormal communication between the subarachnoid space and the nasal or middle ear cavity. It is generally classified as traumatic, nontraumatic (ie, spontaneous), or postsurgical in origin, 1 and most cases are traumatic. Approximately 70% of traumatic CSF fistulas close spontaneously within 1 week after injury without surgical intervention.2-4 However, even in cases of mild CSF rhinorrhea or early spontaneous closure, patients remain at risk of recurrent CSF leakage, pneumocephalus, and infectious meningitis. Precise identification of the location of the CSF fistula allows proper surgical planning, increases the chance of dural repair, and can prevent complications. 5,6 Numerous techniques, including plain skull radiography, intraoperative injection of fluorescein dye, positive contrast (iophendylate) studies, and radionuclide cisternography, are all helpful in limited ways.7-12 MR imaging with T2-weighted sequences has been used to localize CSF fistulas. The demonstration of high-signal-intensity fluid extending from the subarachnoid space directly into the adjacent paranasal sinuses or herniation of the brain into a sinus through a bone defect has been the principal diagnostic criterion.2,13-18 However, some or all of these findings can occasionally be observed in the absence of fistula formation on MR images obtained for reasons other than CSF leakage. The most common method for evaluating a patient with suspected CSF rhinorrhea is a combination of thin-section CT and subsequent CT cisternography (CTC). Although high-resolution CT (HRCT) is sufficient to show bony defects in the skull base...

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Gadolinium encephalopathy due to accidental intrathecal administration of gadopentetate dimeglumine

Cited by 50 publications

References 8 publications

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

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

Neurotoxic Manifestations of an Overdose Intrathecal Injection of Gadopentetate Dimeglumine

Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage

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