Iohexol
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Ascending tonic-clonic seizure: case report A 47-year-old woman developed ascending tonic-clonic seizure syndrome during treatment with iohexol. The woman presented for clear and salty water leakage from her right nasal hole. Upon examination, the salty water was confirmed as cerebrospinal fluid. She was scheduled for computed cisternography. During the lumbar puncture, she received intrathecal iohexol 10mL [Omnipaque]. Following 20 minutes of the iohexol injection, she developed spasm followed by a convulsive construction, which further developed to generalised tonic-clonic seizure. She felt down on the stretcher and hit her nose to the barr, which led to epistaxis. Therefore, the woman was shifted to the shock room in the emergency unit. She was unconscious. Immediately, she was administered diazepam, which controlled her seizures. Later, she was given glucose [dextrose] and sodium chloride [saline]. Further, she had the second episode of generalised tonicclonic seizure secondary to the start of focal contraction in her right arm. This was controlled with additional doses of diazepam. Further, she underwent CT cisternography. She was intubated due to possible anaphylactic shock secondary to superficial respiration. She was premedicated with midazolam and atracurium besilate [Atracurium]. Following two minutes of the intubation, she developed the third episode of generalised tonic-clonic convulsion. Therefore, she was treated with phenytoin infusion. However, she had one more generalised tonic-clonic convulsion after a few seconds of the completion of phenytoin infusion. Therefore, her treatment was switched to midazolam. On account of having three more tonic-clonic seizures despite the midazolam infusion, she was diagnosed with resistant status epilepticus. An anaesthesiologist was consulted for sedation protocol during mechanical ventilation. Her CT cisternography procedure was continued. She received prophylactic subarachnoid haemorrhage medical treatment. Further, she did not have any seizure episode. She was discharged with phenytoin. Author comment: "Ascending tonic-clonic seizure (ATCS) syndrome secondary to Iohexole is a rare, potentially fetal status epilepticus condition". Pestilci Z, et al. Ascending tonic-clonic seizure syndrome secondary to iohexol during CT cisternography: Case report. Journal of Neurological Sciences 30: 445-450, No. 2, Jan 2013. Available from: URL: https://www.researchgate.net/ publication/288612442_Ascending_TonicClonic_Seizure_Syndrome_Secondary_To_Iohexol_During_CT_Cisternography_Case_Report 803443530 - Turkey
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Reactions 4 Jan 2020 No. 1785
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