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The histologic effect of intraventricular injection of metrizamide
Abstract:
A patient with sudden apoplexy and coma was found to have hydrocephalus on computed tomographic scan, and metrizamide was instilled into the ventricles. Subsequent autopsy disclosed a brainstem infarct secondary to a primary dissecting aneurysm of the basilar artery, and a histologic picture of encephalitis in the walls of the lateral and third ventricles. Metrizamide may cause pathologic changes that must be recognized for the correct interpretation by the pathologist of tissue sections previously exposed to metrizamide. In the present case, the changes were seen 11 days after exposure of the tissue to metrizamide, consonant with the time course of similar changes observed in animals. The localization of the cellular infiltrates to the Virchow-Robin spaces corroborates evidence from the literature that metrizamide enters brain parenchyma via these spaces.
Insights
Metrizamide contrast media can cause encephalitis in brain ventricles, mimicking other conditions. Pathologists must recognize these metrizamide-induced changes for accurate diagnosis after ventricular instillation.
Area of Science:
- Neuropathology
- Neuroradiology
- Medical Imaging
Background:
- Computed tomography (CT) scans revealed hydrocephalus in a patient presenting with sudden apoplexy and coma.
- Metrizamide, a contrast agent, was administered intrathecally into the patient's ventricles.
Observation:
- Autopsy examination identified a brainstem infarct attributed to a dissecting aneurysm of the basilar artery.
- Histological analysis of the lateral and third ventricles revealed encephalitis.
Findings:
- Metrizamide exposure was associated with pathological changes in the ventricular walls, observed 11 days post-administration.
- These changes, characterized by cellular infiltrates within Virchow-Robin spaces, suggest metrizamide's entry into brain parenchyma.
Implications:
- Recognizing metrizamide-induced neuropathology is crucial for accurate interpretation of tissue samples in diagnostic pathology.
- The findings highlight the importance of considering contrast media effects in post-mortem examinations and neurological assessments.