Provenzano David Anthony, Pellis Zachary, DeRiggi Leonard
Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA
Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA.
Reg Anesth Pain Med. 2019 Apr 25. doi: 10.1136/rapm-2019-100422.
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 encephalopathy and the first published case of intrathecal gadoteridol causing serious neurologic complications. In addition, the case presented here is placed in context with an associated comprehensive, evidence-based review of the use of gadolinium in interventional pain procedures, addressing gadolinium chemistry and pharmacologic properties, neurotoxicity and radiology. Physicians must be aware that gadolinium poses a significant risk of acute neurotoxicity even in small doses. Until further safety research is performed, GBCAs should not be considered a safe alternative for use in neuraxial interventional spine procedures when there is a risk of inadvertent intrathecal administration.
钆基对比剂（GBCAs）已被建议作为基于碘的对比剂的非标签替代品，用于介入性疼痛治疗过程中的荧光透视成像。我们报告了1例在神经轴介入性疼痛治疗过程中意外鞘内注射GBCA导致急性钆神经毒性的病例，该毒性导致脑病并最终死亡。据我们所知，这是首例发表的致命性鞘内钆诱导脑病病例，也是首例发表的鞘内注射钆特醇导致严重神经并发症的病例。此外，本文介绍的病例还结合了对钆在介入性疼痛治疗中应用的相关全面、基于证据的综述，涉及钆的化学和药理特性、神经毒性及放射学。医生必须意识到，即使是小剂量的钆也存在急性神经毒性的重大风险。在进行进一步的安全性研究之前，当存在意外鞘内注射风险时，GBCAs不应被视为用于神经轴介入性脊柱手术的安全替代品。
