Intracerebral Hemorrhage after Lumbar Myelography with Iohexol: Report of a Case and Review of the Literature

Kelft, Erik Van de; Bosmans, Jan; Parizel, Paul M.; Vyve, M. Van; Selosse, P

doi:10.1227/00006123-199104000-00014

Cited by 50 publications

(13 citation statements)

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“…Very few cases of intracerebral hemorrhage complicating lumbar puncture have been reported, and these have always been located in a cerebral hemisphere (10). To our knowledge, no previous case of posterior fossa hemorrhage following transsphenoidal surgery has been reported.…”

Section: Discussionmentioning

confidence: 86%

Cerebellar hematoma following transsphenoidal surgery

et al. 2005

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Cerebellar hemorrhage after supratentorial surgery is a very infrequent complication. Most cases occur following aneurysm or brain tumor surgery, or evacuation of extracerebral collections. The underlying mechanism of formation of these hematomas is unclear. We present an example of cerebellar hemorrhage following transsphenoidal resection of a pituitary adenoma. To our knowledge, this is the first case reported of hemorrhage in the posterior fossa after a transsphenoidal approach.

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Section: Discussionmentioning

confidence: 86%

Cerebellar hematoma following transsphenoidal surgery

et al. 2005

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“…5 Mild neckache and backache are also not unusual. Complications of myelography include seizure, aseptic meningitis, 7-10 meningoencephalitis, [11][12][13] bacterial meningitis, 14 intracranial hemorrhage, 15 spinal hematoma, 16 encephalopathy, 17 transient confusion, 18,19 and paraplegia. 20 Aseptic meningitis or meningoencephalitis after iohexol myelography is very rare.…”

Section: Discussionmentioning

confidence: 99%

Aseptic Meningoencephalitis after Iohexol CT Myelography

Romesburg¹,

Ragozzino²

2008

AJNR Am J Neuroradiol

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SUMMARY:We describe the case of a patient with aseptic meningoencephalitis after intrathecal iohexol injection for myelography and review the previous literature on similar cases of contrastinduced neurotoxicity.A septic meningoencephalitis is a rare complication of myelography with nonionic, iodinated, water-soluble contrast agents. We describe a case of a 69-year-old woman in whom aseptic meningoencephalitis developed after she underwent iohexol myelography. Case ReportA 69-year-old white woman underwent a technically successful outpatient CT myelogram with 10 mL of iohexol (Omnipaque 300; GE Healthcare, Cork, Ireland). The CSF was clear and colorless, and myelogram revealed degenerative osteoarthritis and severe central canal stenosis at L3-L4 secondary to short pedicles, facet and ligamentum flavum hypertrophy, and diffuse disk bulging. Approximately 12 hours after the injection, she experienced fever, headache, confusion, agitation, and aphasia. She was brought to the emergency department 20 hours after the myelogram.In the emergency department, her initial temperature was 102.5°F, and she was agitated and unable to speak, though she could shake and nod her head for "yes" or "no" responses. She complained of a severe headache and low back pain but denied incontinence or lower extremity numbness. On physical examination, she had mild symmetric lower extremity weakness that measured 4 of 5 bilaterally. Her serum white blood cell count (WBC) was 24,300 cells/L (90% neutrophils). Head CT revealed moderate to severe, chronic, smallvessel ischemic disease. Lumbar puncture and CSF analysis approximately 30 hours after the iohexol injection revealed turbid-appearing fluid with 300 white cells/L (61% polymorphonuclear cells and 1% monocytes), 5200 red cells/L, glucose level of 63 mg/dL, and elevated total protein level of 624 mg/dL. A second tube of CSF from the same lumbar puncture revealed 220 white cells/L (94% polymorphonuclear cells and 2% lymphocytes) and 1545 red cells/L. Results of CSF bacterial and cryptococcal antigens were negative. CSF culture revealed no growth at 5 days.She was initially started on intravenous ceftriaxone (2000 mg) and vancomycin (1000 mg) every 12 hours. The following day, approximately 48 hours after the myelogram, she was afebrile, and her mental status and neurologic examination had returned to near baseline with fluent speech. She was alert and oriented, with no recollection of the previous day, and complained only of a bandlike headache. An infectious disease consultation was obtained, and the patient was diagnosed with an allergic reaction to the iohexol. Diagnosis was based on the negative Gram stain result, negative culture result, and rapid resolution. Antibiotics were discontinued after results of CSF tests, blood tests, and urine cultures remained negative.

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“…Faulty technique during lumbar puncture can cause significant CSF leakage resulting in low intracranial pressure leading to traction and rupture of the dilated, thin-walled dural blood vessels [5][6][7].…”

Section: Intracranial Bleed Following Intrathecal Methotrexatementioning

confidence: 99%