Fatal gadolinium-induced encephalopathy following accidental intrathecal administration: a case report and a comprehensive evidence-based review

@article{Provenzano2019FatalGE,
  title={Fatal gadolinium-induced encephalopathy following accidental intrathecal administration: a case report and a comprehensive evidence-based review},
  author={David Anthony Provenzano and Zachary Pellis and Leonard DeRiggi},
  journal={Regional Anesthesia \& Pain Medicine},
  year={2019},
  volume={44},
  pages={721 - 729}
}
Gadolinium-based contrast agents (GBCAs) have been suggested as off-label alternatives to iodine-based contrast agents for fluoroscopic imaging during interventional pain procedures. We report a case of accidental intrathecal administration of a GBCA during a neuraxial interventional pain procedure leading to acute gadolinium neurotoxicity, which resulted in encephalopathy and ultimately death. To our knowledge, it is the first published case of fatal intrathecal gadolinium-induced… 

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Intrathecal gadolinium: a fatal flaw

  • T. Maus
  • Medicine
    Regional Anesthesia & Pain Medicine
  • 2019
The timely case report and review of the literature by Provenzano et al illuminates the risks associated with the use of a gadolinium-based contrast agent (GBCA) in neuraxial interventional pain procedures.

Intrathecal Gadolinium Use for the Chronic Pain Physician

This work sought to provide a resource for chronic pain physicians treating an iodine‐allergic patient and considering the use of IT gadolinium.

Man with altered mental status

A 67-year-old man with C7-T1 radiculopathy and iodine contrast allergy presented to the emergency department with altered mental status and the use of gadolinium (2 mL gadobutrol) as an alternative agent to confirm uptake into the epidural space.

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