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Aseptic meningoencephalitis after iohexol CT myelography

J Romesburg1, M Ragozzino

  • 1Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA. jromesbu@wfubmc.edu

AJNR. American Journal of Neuroradiology
|November 29, 2008
PubMed

Insights

Aseptic meningoencephalitis occurred in a patient after intrathecal iohexol injection for myelography. This case highlights the risk of contrast-induced neurotoxicity, even with non-ionic, low-osmolar agents.

Area of Science:

  • Neurology
  • Radiology
  • Toxicology

Background:

  • Myelography is an imaging procedure used to visualize the spinal cord and surrounding structures.
  • Intrathecal contrast agents are injected directly into the cerebrospinal fluid for myelography.
  • Iohexol is a non-ionic, low-osmolar contrast medium commonly used for such procedures.

Observation:

  • A patient developed aseptic meningoencephalitis following intrathecal iohexol injection.
  • Symptoms included severe headache, fever, and nuchal rigidity, indicative of meningeal irritation.
  • Cerebrospinal fluid analysis revealed pleocytosis and elevated protein, consistent with an inflammatory process.

Findings:

  • The patient's condition improved with supportive care and corticosteroids.
  • Literature review identified a pattern of neurotoxicity associated with intrathecal contrast agents.
  • Iohexol, despite its favorable safety profile, can precipitate aseptic meningoencephalitis in susceptible individuals.

Implications:

  • This case underscores the importance of recognizing contrast-induced neurotoxicity as a potential complication of myelography.
  • Clinicians should consider aseptic meningoencephalitis in the differential diagnosis of neurological symptoms post-myelography.
  • Further research may elucidate the precise mechanisms and risk factors for contrast-induced neurotoxicity.

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