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A blast from the past: Incidental Pantopaque deposition in a patient with acute stroke who underwent successful
Rainier Mark Loidor L Rapal1, James Siegler2, Michael Hurley3
1Child Neurology Resident PGY-4, University of Chicago, Department of Child Neurology, 5721 S Maryland Ave, Chicago, IL 60637, USA.
Background:
Pantopaque (iofendylate) was an oil-based myelographic contrast used until the 1980s. Residual deposits can persist for decades and mimic acute pathology on neuroimaging.
Clinical Case:
An 86-year-old woman with vascular risk factors and lung cancer presented with acute left hemiparesis and facial droop (NIHSS 17). Non-contrast CT showed multiple cortical and sulcal hyperdensities, raising concern for hemorrhage or metastases. CT angiography revealed a right M1 occlusion. She underwent successful thrombectomy (TICI 3) with excellent recovery (NIHSS 1 at discharge). Further review revealed a prior Pantopaque myelogram in the 1980s, and the hyperdensities were recognized as retained contrast droplets.
Conclusion:
Residual Pantopaque may mimic hemorrhage or metastases on CT. Recognition of its characteristic appearance, combined with awareness of historical myelography, is essential to prevent misdiagnosis. This case is unusual for its right-sided dependence, a rarely reported distribution pattern.
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