Inadvertent intraoperative myelography with Hypaque: case report and discussion.
BACKGROUND
Myelography is routinely performed safely using nonionic water-soluble radiographic contrast media. However, inadvertent introduction of ionic contrast media into the thecal space can result in a syndrome of spasms and convulsions, which can lead to death if not recognized and dealt with in a timely manner.


METHODS
We report a case of inadvertent use of the ionic diatrizoate meglumine, an ionic contrast agent, instead of a nonionic contrast agent during intraoperative myelography.


RESULTS
The patient developed a sterotypical syndrome of ascending myoclonic spasms, resulting in rhabdomyolysis. Treatment included elevation of the head, removal of cerebrospinal fluid, administration of anticonvulsants, diuresis and sedation, and neuromuscular blockade. The patient recovered well, and there were no long-term sequelae.


CONCLUSIONS
Intrathecal introduction of ionic contrast media and the resultant syndrome must be recognized promptly and treated with aggressive medical management to address rhabdomyolysis and seizures. Ionic contrast media should be stored and marked in such a way as to avoid inadvertent use in myelography.
Killeffer
J A
JA
Department of Neurosurgery, West Virginia University School of Medicine, Morgantown 26506-9183, USA.
Kaufman
H H
HH
D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D003974:Diatrizoate Meglumine / Q000009:adverse effects*; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects*; D008297:Male; D009192:Myelography / Q000009:adverse effects*; D009207:Myoclonus / Q000139:chemically induced* / Q000628:therapy*; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000628:therapy*
D003287:Contrast Media; D003974:Diatrizoate Meglumine