J Korean Med Sci.  2010 Mar;25(3):505-508. 10.3346/jkms.2010.25.3.505.

Neurotoxic Manifestations of an Overdose Intrathecal Injection of Gadopentetate Dimeglumine

• Park KW
• Im SB
• Kim BT
• Hwang SC
• Park JS
• Shin WH

• KMID: 1778054
• DOI: http://doi.org/10.3346/jkms.2010.25.3.505

Abstract

The intravenous administration of gadopentetate dimeglumine (GD) is relatively safe and rarely causes systemic toxicity in the course of routine imaging studies. However, the general safety of intrathecal GD has not been established. We report a very rare case of an overdose intrathecal GD injection presenting with neurotoxic manifestations, including a decreased level of consciousness, global aphasia, rigidity, and visual disturbance.

Keyword

Neurologic Manifestations; Injections, Spinal; Gadolinium DTPA

MeSH Terms

Adult
Aphasia/etiology/pathology/physiopathology
Brain/drug effects/pathology
*Contrast Media/administration & dosage/toxicity
*Gadolinium DTPA/administration & dosage/toxicity
Humans
*Injections, Spinal
Male
Muscle Rigidity/etiology/pathology/physiopathology
*Neurotoxicity Syndromes/etiology/pathology/physiopathology
Tomography, X-Ray Computed
Vision Disorders/etiology/pathology
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 Brain CT images about 10 hr after the administration of GD showing diffuse high density throughout the subarachnoid space. (A) At the level of basal cisterns and (B) sylvian fissure.

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  Fig. 2 Conventional digital subtraction angiographies showing no definite vascular abnormality. (A) Right internal carotid artery (ICA), anteroposterior (AP) view. (B) Left ICA, AP view. (C, D) Left vertebral artery, AP (C) and lateral (D) view.

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  Fig. 3 Follow-up brain CT images on day 4 after admission. The diffuse high density throughout the subarachnoid space had disappeared. (A) At the level of basal cisterns and (B) sylvian fissure.

Reference

1. Maramattom BV, Manno EM, Wijdicks EF, Lindell EP. Gadolinium encephalopathy in a patient with renal failure. Neurology. 2005. 64:1276–1278.

2. Tali ET, Ercan N, Krumina G, Rudwan M, Mironov A, Zeng QY, Jinkins JR. Intrathecal gadolinium (gadopentetate dimeglumine) enhanced magnetic resonance myelography and cisternography: results of a multicenter study. Invest Radiol. 2002. 37:152–159.

3. Niendorf HP, Haustein J, Cornelius I, Alhassan A, Clauss W. Safety of gadolinium-DTPA: extended clinical experience. Magn Reson Med. 1991. 22:222–228.

4. Goldstein HA, Kashanian FK, Blumetti RF, Holyoak WL, Hugo FP, Blumenfield DM. Safety assessment of gadopentetate dimeglumine in U.S. clinical trials. Radiology. 1990. 174:17–23.

5. Zeng Q, Xiong L, Jinkins JR, Fan Z, Liu Z. Intrathecal gadolinium-enhanced MR myelography and cisternography: a pilot study in human patients. AJR Am J Roentgenol. 1999. 173:1109–1115.

6. Di Chiro G, Knop RH, Girton ME, Dwyer AJ, Doppman JL, Patronas NJ, Gansow OA, Brechbiel MW, Brooks RA. MR cisternography and myelography with Gd-DTPA in monkeys. Radiology. 1985. 157:373–377.

7. Ray DE, Cavanagh JB, Nolan CC, Williams SC. Neurotoxic effects of gadopentetate dimeglumine: behavioral disturbance and morphology after intracerebroventricular injection in rats. AJNR Am J Neuroradiol. 1996. 17:365–373.

8. Ray DE, Holton JL, Nolan CC, Cavanagh JB, Harpur ES. Neurotoxic potential of gadodiamide after injection into the lateral cerebral ventricle of rats. AJNR Am J Neuroradiol. 1998. 19:1455–1462.

9. Tali ET, Ercan N, Kaymaz M, Pasaoglu A, Jinkins JR. Intrathecal gadolinium (gadopentetate dimeglumine)-enhanced MR cisternography used to determine potential communication between the cerebrospinal fluid pathways and intracranial arachnoid cysts. Neuroradiology. 2004. 46:744–754.

10. Arlt S, Cepek L, Rustenbeck HH, Prange H, Reimers CD. Gadolinium encephalopathy due to accidental intrathecal administration of gadopentetate dimeglumine. J Neurol. 2007. 254:810–812.

11. Li L, Gao FQ, Zhang B, Luo BN, Yang ZY, Zhao J. Overdosage of intrathecal gadolinium and neurological response. Clin Radiol. 2008. 3:1063–1068.