Malignant Cerebral Edema following CT Myelogram Using Isovue-M 300 Intrathecal Nonionic Water-Soluble Contrast: A Case Report

Kelley, Brian C.; Roh, Simon; Johnson, Philip L.; Arnold, Paul M.

doi:10.1155/2011/212516

Cited by 4 publications

(2 citation statements)

References 59 publications

(60 reference statements)

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“…3 However, even lowosmolar, nonionic agents have been shown to potentially cause malignant cerebral edema and transient encephalopathy, presumably via disruptions in the bloodebrain barrier that might accompany increasing age, hypertension, and cerebrovascular ischemia, among other factors. 4,5 Parietooccipital areas of the brain are thought to be more sensitive to this effect, which would be consistent with this case. [6][7][8] Awareness of this potential adverse reaction to nonionic, low-osmolar agents after intrathecal use in patients at risk, such as the elderly or those with mildly impaired renal function, can help internists and hospitalists optimize high value care.…”

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confidence: 83%

Diffuse Cerebral Edema After CT Myelography Causing Focal Neurological Symptoms

Williams

Sweet

Morton

et al. 2017

The American Journal of Medicine

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Adverse effects of nonionic contrast agents are rare. We present a case of diffuse cerebral edema and neurological deficits after computed tomography (CT) myelography that resolved without specific intervention.An 80-year-old woman presented with left-sided weakness, left facial droop, and slurred speech. Two days prior, she underwent CT myelography for evaluation of her lower back pain. Twelve milliliters of iohexol (Omnipaque 180 mgI/mL; GE Healthcare, Pittsburgh, Pa) were injected into the L3-L4 interlaminar lumbar space using a 22-gauge spinal needle with the patient in prone position. She was taking 5 mg of apixaban twice daily for atrial fibrillation, which was discontinued 5 days prior to the procedure and restarted afterward. The dysarthria started the night prior to admission, followed by left-sided hemiparesis and left facial droop. Her medical history included nonischemic cardiomyopathy, hypertension, and a left parietal stroke 2 years earlier, without residual deficit. A biventricular implantable cardioverter-defibrillator was in place. Her medications include losartan, carvedilol, furosemide, levothyroxine, and pregabalin. Physical examination revealed partial flattening of the left nasolabial fold with sparing of the forehead, left grip strength weaker than the right, 4/5 strength in the left upper and left lower extremities, and normal strength in the right upper and lower extremities. Aside from an estimated glomerular filtration rate of 51 mL/min/1.73m 2 , laboratory studies and electrocardiography were unremarkable. CT of the head showed diffuse cerebral edema with gyral swelling and loss of sulci, effacement of the basal cisterns, and hypoattenuation of the cerebral white matter. There was no intracranial hemorrhage or shift. The presence of the implantable cardioverter-defibrillator precluded magnetic resonance imaging. The initial concern was for a multifocal embolic stroke. However, her signs and symptoms completely resolved gradually over the next 48 hours. Repeat brain CT 2 days after the onset of her symptoms showed marked improvement of the cerebral edema and resolution of the white matter hypodensities. She was discharged on her fourth hospital day with no residual neurological deficits.

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confidence: 83%

Diffuse Cerebral Edema After CT Myelography Causing Focal Neurological Symptoms

Williams

Sweet

Morton

et al. 2017

The American Journal of Medicine

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“…In a retrospective analysis, Klein et al report a risk of seizures in nonepileptic individuals and risk of status epilepticus in patients with epilepsy who have received Iopamidol myelography [ 13 ]. Kelley et al described a case of cerebral edema in a 50-year-old female patient who presented with increased somnolence, headache, and visual changes a day following CT myelogram with Iopamidol [ 14 ]. Other reported cases have also described similar complications.…”

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confidence: 99%

Vasogenic Cerebral Edema following CT Myelogram with Nonionic Omnipaque 300

Khodor

Blumenthal

2018

Case Reports in Neurological Medicine

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Computed Tomography (CT) with myelogram is a relatively safe procedure. It requires the use of nonionic contrast agents which, unlike ionic contrast agents, have been associated with low complication rates. We report a case of a 69-year-old female who developed diffuse bilateral cerebral edema following a lumber myelogram with the use of intrathecal nonionic contrast agent Omnipaque (Iohexol) 300. We were able to find one other reported case of cerebral edema following the use of intrathecal nonionic contrast agent in the literature.

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The role of CT myelography in sparing the spinal cord during definitive radiotherapy in vertebral hemangioma

Sudha

Gopalakrishnan

Saravanan³

2017

J Applied Clin Med Phys

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IntroductionThe spinal cord is poorly visualized on CT images but is well visualized in MRI images. However, implants used for spinal stabilization can produce artifacts on the MRI images which can interfere with identification of the cord. CT myelography in conjunction with CT simulation helps to clearly delineate the cord.Materials and methods CT simulation was done in a patient with vertebral hemangioma. Pre‐ and post myelography images were obtained. Two plans were generated on pre and post myelography CT images using Eclipse™ treatment planning system (TPS) version 10.0, Varian Medical Systems, USA. The prescribed total dose to PTV was 40 Gy in 20 fractions.ResultsThe cord was poorly visualized in the premyelogram CT images. The titanium implants used for spinal cord stabilization produced artifacts in the MRI images. Figure 1 Post myelogram, the contrast lit up the spinal cord.There was an overlap of 0.75 cc volume of the spinal cord with the PTV in the premyelogram images. This volume was reduced to 0 cc in the post myelogram images. There was an overlap of 5.4 cc volume of the PRV of spinal cord with the PTV in the premyelogram images which was reduced to 1 cc in the post myelogram images. The overlap region between the PTV and spinal cord received around 71% of the prescribed dose in premyelogram CT could be reduced to 0% in the post myelogram CT. The mean dose received by the overlap PRV spinal cord and PTV could be increased from 70% in the premyelogram to 92% in the post myelogram plans.Conclusion CT myelogram in conjunction with CT simulation is particularly useful in cases where the tumor margin is very close to the cord and spinal implants are causing distortion of magnetic resonance images.

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Malignant Cerebral Edema following CT Myelogram Using Isovue-M 300 Intrathecal Nonionic Water-Soluble Contrast: A Case Report

Cited by 4 publications

References 59 publications

Diffuse Cerebral Edema After CT Myelography Causing Focal Neurological Symptoms

Diffuse Cerebral Edema After CT Myelography Causing Focal Neurological Symptoms

Vasogenic Cerebral Edema following CT Myelogram with Nonionic Omnipaque 300

The role of CT myelography in sparing the spinal cord during definitive radiotherapy in vertebral hemangioma

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