Advertisement

Acute Encephalopathy and Cardiac Arrest Induced by Intrathecal Gadolinium Administration

  • Bianca BesteherEmail author
  • Ha-Yeun Chung
  • Thomas E. Mayer
  • Otto W. Witte
  • Klaus Kirchhof
  • Matthias Schwab
Correspondence
  • 38 Downloads

Introduction

Intravenously applied gadolinium-based contrast agents (GBCA) are widely used for magnetic resonance imaging (MRI) diagnostics in all clinical disciplines. They are considered safe with overall rates of less than 2.4% of acute allergic and non-allergic reactions [1]. Severe adverse effects, such as cardiac arrest [2] occur in 0.0–0.03% when administered in commonly used dosages. Intrathecal use of GBCA has been used off-label for several indications, especially for diagnosis of cerebrospinal fluid (CSF) leaks and is mostly well-tolerated [3]. This article reports an unusual case with acute onset encephalopathy and cardiac arrest following diagnostic intrathecal administration of gadobutrol.

Case Presentation

A 69-year-old Caucasian female was admitted to the neurological unit with repetitive severe (visual analogue scale, VAS 7/10), bitemporal headaches lasting minutes after coughing, pressing or lifting heavy objects. Symptom onset had been 12 months earlier following...

Notes

Compliance with ethical guidelines

Conflict of interest

B. Besteher, H.-Y. Chung, T.E. Mayer, O.W. Witte, K. Kirchhof and M. Schwab declare that they have no competing interests.

Ethical standards

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the patient included in this report.

References

  1. 1.
    Kanal E. Gadolinium based contrast agents (GBCA): safety overview after 3 decades of clinical experience. Magn Reson Imaging. 2016;34:1341–5.CrossRefGoogle Scholar
  2. 2.
    Unal O, Arslan H. Cardiac arrest caused by IV gadopentetate dimeglumine. AJR Am J Roentgenol. 1999;172:1141.CrossRefGoogle Scholar
  3. 3.
    Tali ET, Ercan N, Krumina G, Rudwan M, Mironov A, Zeng QY, Jinkins JR. Intrathecal gadolinium (gadopentetate dimeglumine) enhanced magnetic resonance myelography and cisternography: results of a multicenter study. Invest Radiol. 2002;37:152–9.CrossRefGoogle Scholar
  4. 4.
    He FF, Li L, Liu MJ, Zhong TD, Zhang QW, Fang XM. Targeted epidural blood patch treatment for refractory spontaneous intracranial hypotension in China. J Neurol Surg B Skull Base. 2018;79:217–23.CrossRefGoogle Scholar
  5. 5.
    Reeves C, Galang E, Padalia R, Tran N, Padalia D. Intrathecal injection of gadobutrol: a tale of caution. J Pain Palliat Care Pharmacother. 2017;31:139–43.CrossRefGoogle Scholar
  6. 6.
    Singh S, Rejai S, Antongiorgi Z, Gonzalez N, Stelzner M. Misconnections in the critically Ill: injection of high-dose gadolinium into an external ventricular drain. A A Case Rep. 2016;6:121–3.CrossRefGoogle Scholar
  7. 7.
    Park KW, Im SB, Kim BT, Hwang SC, Park JS, Shin WH. Neurotoxic manifestations of an overdose intrathecal injection of gadopentetate dimeglumine. J Korean Med Sci. 2010;25:505–8.CrossRefGoogle Scholar
  8. 8.
    Deike-Hofmann K, Reuter J, Haase R, Paech D, Gnirs R, Bickelhaupt S, Forsting M, Heußel CP, Schlemmer HP, Radbruch A. Glymphatic pathway of gadolinium-based contrast agents through the brain: overlooked and misinterpreted. Invest Radiol. 2019;54:229–37.CrossRefGoogle Scholar
  9. 9.
    Jinkins JR, Rudwan M, Krumina G, Tali ET. Intrathecal gadolinium-enhanced MR cisternography in the evaluation of clinically suspected cerebrospinal fluid rhinorrhea in humans: early experience. Radiology. 2002;222:555–9.CrossRefGoogle Scholar
  10. 10.
    Zeng Q, Xiong L, Jinkins JR, Fan Z, Liu Z. Intrathecal gadolinium-enhanced MR myelography and cisternography: a pilot study in human patients. AJR Am J Roentgenol. 1999;173:1109–15.CrossRefGoogle Scholar
  11. 11.
    Ray DE, Holton JL, Nolan CC, Cavanagh JB, Harpur ES. Neurotoxic potential of gadodiamide after injection into the lateral cerebral ventricle of rats. AJNR Am J Neuroradiol. 1998;19:1455–62.PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyJena University HospitalJenaGermany
  2. 2.Department of Psychiatry and PsychotherapyJena University HospitalJenaGermany
  3. 3.Department of NeuroradiologyJena University HospitalJenaGermany

Personalised recommendations