Extradural application of bismuth iodoform paraffin paste causing relapsing bismuth encephalopathy: a case report with CT and MRI studies.
Bismuth iodoform paraffin paste (BIPP) is used in dressings in ear, nose, and throat, dental, and neurosurgical practice. Neurotoxicity due to absorption of bismuth from the BIPP pack is rare. It is preventable and reversible but likely to be fatal if unrecognised. A case of relapsing but reversible toxic encephalopathy due to a large extradural BIPP pack is reported in a 57 year old Caucasian woman, operated on for a huge basal cell carcinoma of the vertex invading the skull and extradural space. Clinical, neuroradiological (CT and MRI), and biochemical studies are presented and discussed in the light of the available literature.
Sharma
R R
RR
Department of Surgical Neurology, Morriston Hospital, Swansea, Wales, UK.
Cast
I P
IP
Redfern
R M
RM
O'Brien
C
C
D001458:Bandages; D001729:Bismuth / Q000009:adverse effects* / Q000097:blood; D001929:Brain Edema / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D002280:Basal Cell Carcinoma / Q000601:surgery*; D003131:Combined Modality Therapy; D004338:Drug Combinations; D015174:Epidural Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D006847:Hydrocarbons, Iodinated / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012008:Recurrence; D012888:Skull Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D004338:Drug Combinations; D006847:Hydrocarbons, Iodinated; C045757:bismuth iodoform paraffin paste; D001729:Bismuth