Intramedullary injection of contrast into the cervical spinal cord during cervical myelography: a case report.
METHODS
A case of iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography is reported.


OBJECTIVE
To investigate the occurrence of iatrogenic intramedullary contrast injection during a current C1-C2 cervical myelography.


BACKGROUND
Intramedullary injection of contrast is a rare but serious complication of C1-C2 cervical myelography that has not been reported since the widespread use of magnetic resonance imaging and the NASCIS III study protocol.


METHODS
A 39-year-old woman received an iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography.


RESULTS
During the procedure the patient reported right-side face, neck, and arm pain and parethesias. After the procedure, right arm weakness and diffuse hyperreflexia developed. Postmyelography imaging demonstrated intramedullary contrast and cord swelling. High-dose methylprednisolone was administered intravenously and the patient's symptoms improved. The literature and management of this rare complication are reviewed.


CONCLUSIONS
Intramedullary cord injection is a rare complication of cervical myelography. The mechanism of spinal cord injury appears to involve a combination of physical compression from the injected liquid and neurotoxicity of the contrast material. Iohexol rather than metrizamide should be used when C1-C2 myelography is indicated in patients who are unable to undergo magnetic resonance imaging, or those whose pathology is inadequately demonstrated magnetic resonance imaging alone. In the event of contrast injection into the spinal cord, administration of high-dose methylprednisolone is recommended.
Simon
Scott L
SL
Department of Neurosurgery, the Hospital of the University of Pennsylvania, and the; Department of Orthopedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
Abrahams
John M
JM
Sean Grady
M
M
LeRoux
Peter D
PD
Rushton
Scott A
SA
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D006987:Hypesthesia / Q000139:chemically induced; D007267:Injections; D007472:Iohexol / Q000008:administration & dosage / Q000009:adverse effects*; D009192:Myelography / Q000379:methods*; D013116:Spinal Cord / Q000187:drug effects* / Q000473:pathology; D013119:Spinal Cord Injuries / Q000139:chemically induced; D013355:Subdural Space
D003287:Contrast Media; D007472:Iohexol