Gadobutrol
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Gadobutrol Pseudo-subarachnoid hemorrhage and gadolinium encephalopathy: case report
A 73-year-old woman developed pseudo-subarachnoid haemorrhage (pSAH) and gadolinium encephalopathy following erroneous intrathecal administration of gadobutrol as a contrast agent [time to reactions onset not stated]. The woman had a medical history of hypertension, diabetes, iodinated contrast allergy and lumbar stenosis. One day after undergoing lumbar epidural steroid injection (LESI), she presented to the emergency department. At presentation, she had altered mental status and a nonfocal neurologic exam. In the emergency department, she had multiple episodes of right gaze deviation and upper extremity tonic posturing, which was suggestive of seizures. An emergent non-contrast CT scan of the head showed diffuse hyperdensity in the subarachnoid spaces, which indicated subarachnoid haemorrhage. The woman was started on levetiracetam [Keppra]. Thereafter, she was admitted to the neurocritical care unit with a concern for possible SAH. Further discussion with the clinician, who performed LESI a day prior to the presentation, informed that she was injected with gadobutrol [Gadavist] 2mL as a contrast agent at the L4-5 level for epidural localisation, prior to the injection of unspecified steroid. However, the procedure was complicated by a dural puncture with possible intrathecal contrast injection (medication error). After admission to neurocritical care unit, MRI and magnetic resonance angiography were performed, which showed diffuse opacification of the CSF spaces with gadolinium. Given the artifact created by gadolinium within the subarachnoid space, the magnetic resonance angiography sequences were non-diagnostic. The next morning, CT scan of the head showed an interval decrease in CSF hyperdensity, and CT of the lumbar spine showed persistent hyperdense material within the thecal sac. She was diagnosed with pSAH and gadolinium encephalopathy. After 6 days, she was discharged to a subacute rehabilitation centre. On discharge, she returned to her preadmission functional neurological baseline without neurologic deficit. She was discharged on levetiracetam treatment with a plan to wean the antiepileptic medication as an outpatient. Platt A, et al. Pseudo-subarachnoid hemorrhage and gadolinium encephalopathy following lumbar epidural steroid injection. Radiology Case Reports 15: 1935-1938, No. 10, 803501575 Oct 2020. Available from: URL: http://doi.org/10.1016/j.radcr.2020.07.075
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Editorial comment: Details of this case report have previously been published and processed for Adis PV [see Reactions 1808 p129; 803479563].
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Reactions 19 Sep 2020 No. 1822
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