Inadvertent intrathecal use of ionic contrast agent

Leede, H. Van Der; Jorens, P. G.; Parizel, Paul M.; Cras, Patrick

doi:10.1007/s00330-002-1417-z

Cited by 24 publications

(37 citation statements)

References 22 publications

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“…13 While most cases occurred during myelography, 1 case occurred during percutaneous nephrography and in another case, contrast reached the spinal cord due to a fistula during sinography of a pelvic abscess. 1,14 One dog received diatrizoate during myelography for pelvic limb paresis, which was followed by hemilaminectomy. The patient required brief ventilatory support for hypoventilation but was reported to be awake with normal thoracic limb function and CNS function within 45 hours.…”

Section: Discussionmentioning

confidence: 99%

“…13 In 11 of the 32 reported human cases, the outcome was fatal. 1 All of the patients that died developed severe seizures, rhabdomyolysis, and multiple organ failure. Early recognition of the problem, intrathecal drainage or lavage, small dose of contrast material injected, and seizure management involving high-dose barbiturates were associated with higher survival rates in people.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 4 hours after contrast media was injected, a cisternal spinal tap was performed based on recommendation from human literature and 1.0 mL (0.16 mL/kg) of grossly normal CSF was removed. 1,3,4 The CSF was not submitted for analysis. The dog's head was elevated and mannitol o (1 g/kg, IV) was administered.…”

Section: Case Summarymentioning

confidence: 99%

“…of ionic contrast material, most commonly during myelography. [1][2][3][4] Nonionic contrast materials rarely cause adverse effects but hyperosmolar ionic contrast agents result in direct neurotoxic damage to the brain and spinal cord parenchyma. Human patients are reported to present with tonic-clonic muscle spasms of the lower extremities that rapidly progress to generalized seizure activity.…”

Section: Introductionmentioning

confidence: 99%

“…The outcome is frequently fatal, with patients developing hyperthermia, rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, and cardiopulmonary arrest. [1][2][3][4] The purpose of this case report is to describe the successful management of a dog with ATCS after inadvertent intrathecal injection of the ionic contrast material diatrizoate during routine myelography. The dog suffered prolonged respiratory arrest, refractory seizure activity, pneumonia, and delayed return to neurologic function but ultimately survived with no permanent effects.…”

Section: Introductionmentioning

confidence: 99%

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Ascending tonic‐clonic seizure syndrome in a dog following inadvertent intrathecal use of ionic contrast agent

Finke

Meola

Mazzaferro

2012

J Vet Emergen Crit Care

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Objective To describe the successful management of ascending tonic‐clonic seizure syndrome in a dog after inadvertent intrathecal administration of ionic contrast material. Case Summary A 7‐year‐old, 5.9 kg, male castrated Miniature Pinscher inadvertently received intrathecal ionic contrast material during a myelogram to investigate cervical pain. Ascending tonic‐clonic muscle spasms quickly progressed to generalized seizure activity that was resistant to anticonvulsant medications. The dog developed complete respiratory arrest, which necessitated mechanical ventilatory support for 26 hours. Pneumonia developed and was treated successfully. After resolution of seizure activity and resumption of voluntary respiration, the dog remained tetraparetic for 16 days and was not able to walk on his own for 20 days post contrast injection. Despite a prolonged recovery, the patient survived and recovered normal neurologic function. New or Unique Information Provided Intrathecal administration of ionic contrast material resulting in ascending tonic‐clonic seizure syndrome is rarely reported in the human and veterinary literature. No previous veterinary report has described successful treatment after prolonged respiratory arrest. In previous veterinary reports, patients recovered complete neurologic function within hours to days in contrast to this report in which the patient was tetraparetic for 16 days. This report demonstrates complete recovery from intrathecal ionic contrast administration is possible despite a high dose of contrast and a prolonged recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Summarymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ascending tonic‐clonic seizure syndrome in a dog following inadvertent intrathecal use of ionic contrast agent

Finke

Meola

Mazzaferro

2012

J Vet Emergen Crit Care

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Formulation of Therapeutics for Neuraxial Infusion

Fairbanks,

Peterson,

Clements

et al. 2023

Neuraxial Therapeutics

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Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

Mizuno

Gauss

Suzuki

et al. 2007

Can J Anesth/J Can Anesth

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CAN J ANESTH 54: 1 www.cja-jca.org Januar y, 2007Purpose: We describe a complication of epiduroscopy with encephalopathy and rhabdomyolysis associated with the contrast medium iotrolan. Clinical features:A 76-yr-old man with failed back surgery syndrome underwent epiduroscopy. Sufficient lysis could not be achieved in the epidural space above the level of L 4 due to dense adhesions and scar tissue. After epidural injections of iotrolan and mepivacaine, he developed motor weakness and hypoesthesia in both legs, which lasted for three hours. He also became confused, agitated, disoriented, and developed neck stiffness and tremors involving the head and legs. Computed tomography revealed diffuse contrast enhancement within the intracranial cerebrospinal fluid (CSF) spaces, indicating an intraoperative dural tear. Marked increases in serum creatinine phosphokinase and myoglobin indicated subsequent acute rhabdomyolysis. Crystalloid infusion and semi-recumbent positioning facilitated iotrolan absorption from the CSF, and the patient recovered uneventfully. Conclusions:Dural tear during epiduroscopy may allow access of contrast media into the CSF. Neurotoxicity secondary to iotrolan within the CSF was a likely contributing factor to the encephalopathy and subsequent rhabdomyolysis. This is an instructive example of the importance of diagnosing inadvertent dural tear during epiduroscopy under iotrolan, for avoidance of adverse events such as encephalopathy and rhabdomyolysis. Eléments cliniques : Un homme de 76 ans présentant des séquelles d'un échec d'une chirurgie aux rachis a subi une épidur-oscopie. Une lyse suffisante n'a pas pu être obtenue dans l'espace péridural au-dessus de L 4 à cause d'adhésions denses et de tissus cicatriciels. Suite à des injections péridurales d'iotrolan et de mépivacaïne, il a développé une parésie ainsi qu'une hypoesthésie au niveau des membres inférieurs qui durèrent trois heures. Il est également devenu confus, agité, désorienté, et a développé une raideur du cou et des tremblements de la tête et des jambes. La tomodensitométrie a révélé un rehaussement diffus du produit de contraste dans les espaces intracrâniens du liquide céphalo-rachidien (LCR), indiquant

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Inadvertent intrathecal use of ionic contrast agent

Cited by 24 publications

References 22 publications

Ascending tonic‐clonic seizure syndrome in a dog following inadvertent intrathecal use of ionic contrast agent

Ascending tonic‐clonic seizure syndrome in a dog following inadvertent intrathecal use of ionic contrast agent

Formulation of Therapeutics for Neuraxial Infusion

Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

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