Inadvertent intrathecal use of ionic contrast agent.
Intrathecal administration of ionic contrast media may cause severe and fatal neurotoxic reactions due to their hyperosmolarity and ionic nature. They are therefore strictly contraindicated for all radiologic applications involving the central nervous system (e.g., myelography). We present a case in which ioxitalamate was accidentally injected intrathecally. The patient recovered completely due to a combination of the different therapeutic options reported in the literature, including early mechanical ventilation and neuromuscular paralysis, aggressive control of seizures, elevation of head and trunk to prevent cephalad migration of contrast, steroids, cerebrospinal fluid drainage and lavage and prophylactic antibiotics.
van der Leede
H
H
Department of Intensive Care Medicine, University Hospital of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Jorens
P G
PG
Parizel
P
P
Cras
P
P
D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007278:Injections, Spinal; D007483:Iothalamic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D007483:Iothalamic Acid; C002587:ioxitalamic acid