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Gadolinium encephalopathy after intrathecal gadolinium injection
Ravish Kapoor1, Jiabin Liu, Ashok Devasenapathy
1Penn State Hershey Medical Center, Hershey, PA, USA.
Pain Physician
|September 23, 2010
Summary
Simultaneous intrathecal injection of gadolinium and blood caused severe neurological complications, including seizures. This case highlights the importance of using low-dose gadolinium in epidural procedures to prevent such adverse events.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Gadolinium-induced encephalopathy is a known complication of intrathecal gadolinium administration.
- Intrathecal blood can also cause neurological changes, including seizures.
- No prior reports documented simultaneous intrathecal injection of gadolinium and blood.
Observation:
- A patient undergoing fluoroscopically-guided epidural steroid injection received a high dose of gadolinium in the epidural space.
- A dural puncture occurred, requiring an epidural blood patch.
- The patient subsequently experienced seizures and altered mental status, necessitating intensive care.
Findings:
- Brain MRI and cerebrospinal fluid (CSF) analysis revealed abnormalities.
- The patient's condition was attributed to inadvertent simultaneous intrathecal injection of gadolinium and autologous blood.
- The patient recovered fully and was discharged.
Implications:
- Reinforces the need for low-dose gadolinium in epidural procedures.
- Emphasizes vigilance for inadvertent intrathecal injection during needle placement confirmation.
- Underscores the potential for severe neurotoxicity from combined intrathecal gadolinium and blood exposure.
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