Moradian Maxim, Tekmyster Gene, Wei Jason J, Avetisian Henry, Acharya Jayant N, Furman Michael B
Interventional Spine and Orthopedic Regenerative Experts, PC (iSCORE). California Sports and Spine Institute, PC (CSSI), 51 N. 5 Ave, Suite 301, Arcadia, CA, 91006, USA.
Assistant Professor of Clinical Orthopaedic Surgery, Keck Medicine of USC, Toyota Sports Performance Center, 555 N. Nash Street, El Segundo, CA, USA.
Interv Pain Med. 2022 Jun 17;1(3):100105. doi: 10.1016/j.inpm.2022.100105. eCollection 2022 Sep.
Raise awareness of gadolinium encephalopathy, a rare cause of neurological symptoms.
An L5-S1 interlaminar epidural steroid injection (IL-ESI) was performed with a gadolinium-based contrast agent (GBCA) due to the patient's history of allergic reaction to iodine-based contrast agents.
Several hours after administration of GBCA, the patient had nausea and vomiting with altered mental status. Patient was treated with dexamethasone IV, and was discharged on day 2. Patient had no residual deficits at follow-up two weeks later. Current literature shows that caution should be used to prevent inadvertent intrathecal GBCA, and doses >2.0 mmols are associated with serious adverse effects, including death.
Intrathecal administration of GBCAs should be limited to less than 0.5 mmol. If adverse effects are experienced, IV steroids should be administered as soon as possible, and a CSF drain should be considered.
提高对钆脑病的认识，这是一种导致神经症状的罕见病因。
因患者有对碘造影剂过敏史，故使用钆基造影剂（GBCA）进行了L5-S1椎板间硬膜外类固醇注射（IL-ESI）。
注射GBCA数小时后，患者出现恶心、呕吐及精神状态改变。患者接受了静脉注射地塞米松治疗，并于第2天出院。两周后的随访中患者无残留缺陷。当前文献表明，应谨慎操作以防止GBCA意外鞘内注射，且剂量>2.0毫摩尔与严重不良反应相关，包括死亡。
GBCA鞘内给药应限制在0.5毫摩尔以下。若出现不良反应，应尽快给予静脉类固醇治疗，并考虑进行脑脊液引流。
