Vasogenic Cerebral Edema following CT Myelogram with Nonionic Omnipaque 300

Khodor, Sara; Blumenthal, Scott L.

doi:10.1155/2018/2761872

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…Although CT myelography is an invasive procedure and infrequently used because of potential complications such as spinal headache, radiculopathy, cerebral edema, or spinal subarachnoid hematoma, 26 , 27 , 28 it may be regarded as a suitable alternative to MRI in selected cases. The administered contrast fills the CSF space around the spinal cord, resulting in good contrast between the spinal cord and CSF so that the spinal cord contours can be delineated.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy

Hammoudeh

Abunimer

Lee

et al. 2023

Advances in Radiation Oncology

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy

Hammoudeh

Abunimer

Lee

et al. 2023

Advances in Radiation Oncology

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“…[3][4][5] Cerebral oedema is also a rare complication of intrathecal contrast injection with few case reports being described in the literature. 2 We are reporting this case so that clinicians are familiar with this uncommon complication of CT myelogram to start early management for better patient outcome.…”

Section: Development Of Vasogenic Cerebral Oedema After Ct Myelogram ...mentioning

confidence: 96%

Development of vasogenic cerebral edema after CT myelogram with nonionic contrast

Angez,

Alam,

Khan

et al. 2024

J Pak Med Assoc

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Madam, Cerebral edema is fluid accumulation in brain because of a cerebral injury such as trauma, ischemia, hemorrhage, abscess, tumors, and poisoning. Based on the pathophysiology it is divided into three types cytotoxic, interstitial and vasogenic, among which vasogenic edema is the commonest type. [1] Vasogenic edema is a very rare complication of CT myelogram. A 42-year-old female known case of diabetes, hypertension, focal segmental necrotizing glomerulonephritis, and permanent pacemaker in situ for ASD secundum presented in December 2020 to Aga Khan University Hospital with backache and progressive bilateral lower limb weakness. On clinical examination she was conscious, alert, and oriented. She had a power of 4/5 and +2 reflexes in both the right and left upper limb and a power of 0/5 and absent reflexes in both the lower limbs. Patient was advised CSF studies and CT myelogram. CT myelogram was performed after a lumbar puncture at L3-L4 level. Approximately 12 mL of non-ionic water-soluble contrast was administered into the spinal canal. CT myelogram was normal. CSF studies showed raised protein. Within less than twelve hours she developed altered sensorium and decreased consciousness. Contrast-enhanced CT brain was performed which showed diffuse effacement of cortical sulci with poor gray-white matter differentiation as shown in Figure 1. There was crowding at the foramen magnum with evidence of tonsillar herniation as shown in Figure 2 and 3. Diagnosis of CT myelogram-induced cerebral edema was made. The patient received mannitol along with steroid pulse therapy. There was interval resolution of cerebral edema and tonsillar herniation on follow up CT brain (Figure 4 and 5). Endocrinology was taken onboard for the management of her diabetes. Five doses of pulse therapy were given, and after a five-day admission and observation the patient was discharged in stable condition. CT lumbar myelogram is a well-tolerated commonly performed procedure that employs intrathecal contrast to outline the subarachnoid space. The adverse effects of intrathecal contrast injection include nausea, headache, vomiting, and dizziness due to increase pressure in the subarachnoid spaces. Rare contrast-induced neurotoxicity, status epilepticus seizures and aseptic meningoencephalitis has also been reported with intrathecal and intravascular nonionic contrast agents. [3–5] Cerebral edema is also a rare complication of intrathecal contrast injection with few case reports being described in the literature. [2] We are reporting this case so that clinicians are familiar with this uncommon complication of CT myelogram to start early management for better patient outcome.

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Intrathecal iodinated contrast-induced transient spinal shock

et al. 2020

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Transient spinal shock is a previously unreported complication of intrathecal contrast. A 63-year-old man presented with the chief complaint of worsening back pain. Computed topography of lumbar spine without contrast showed a lytic lesion. After international normalized ratio (INR) correction, patient was sent for CT myelogram. After intrathecal contrast injection, the patient dropped his blood pressure profoundly and developed clinical manifestations of spinal shock. Emergent intravenous bolus fluids were initiated resulting in improvement in blood pressure. Patient’s spinal shock resolved within hours. CT myelogram was normal except previously known lytic lesion. It was concluded that the transient shock was most likely due to contrast injection. We believe that this is the first reported case of transient spinal shock following CT myelogram using water-soluble iodinated non-ionic contrast agent administered intrathecally.

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Vasogenic Cerebral Edema following CT Myelogram with Nonionic Omnipaque 300

Cited by 3 publications

References 20 publications

Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy

Spinal Cord Delineation Based on Computed Tomography Myelogram Versus T2 Magnetic Resonance Imaging in Spinal Stereotactic Body Radiation Therapy

Development of vasogenic cerebral edema after CT myelogram with nonionic contrast

Intrathecal iodinated contrast-induced transient spinal shock

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