title: Accidental Intrathecal Injection of Ionic Contrast: Case Report and Review of the Literature.
abstract: BACKGROUND
  Ionic contrast, if accidentally injected into the intrathecal space during routine imaging studies or interventional procedures, may significantly interfere with neuronal activity, potentially causing ascending tonic-clonic seizure syndrome and even death. As a result, ionic contrast is strictly contraindicated for intrathecal use. Rapid recognition of the condition followed by prompt management, typically involving aggressive cerebrospinal fluid (CSF) drainage, is critical to improving patient outcome. Lumbar drain has previously been well described as a management strategy.
  
  
  METHODS
  We present a case of accidental intrathecal injection of an ionic contrast agent, iothalamate meglumine, in a patient undergoing cervical epidural steroid injection. This patient was managed successfully with drainage of CSF using an external ventricular drain alone.
  
  
  CONCLUSIONS
  Our literature review and analysis of the previously published cases demonstrate that aggressive CSF drainage is essential to improve outcomes, and in some cases an external ventricular drain alone may be effectively used.
authors.affiliation: Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Electronic address: joseph-hudson@uiowa.edu.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Hudson
authors.affiliation: Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Abode-Iyamah
authors.affiliation: Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Nagahama
authors.affiliation: Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Chandan G
authors.initials: CG
authors.lastname: Reddy
mesh_terms: D001927:Brain Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects; D007482:Iothalamate Meglumine / Q000008:administration & dosage / Q000009:adverse effects*; D008508:Medication Errors / Q000009:adverse effects* / Q000517:prevention & control*; D008875:Middle Aged; D011220:Pralidoxime Compounds / Q000008:administration & dosage / Q000009:adverse effects; D013122:Spinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
chemical_list: D011220:Pralidoxime Compounds; C028797:pralidoxime; D007482:Iothalamate Meglumine
keywords: Accidental intrathecal injection; Ascending tonic-clonic seizure syndrome; Ionic contrast; Myelography