Table 2

Previous cases of intrathecal gadolinium neurotoxicity*

AuthorProcedureGBCA† dose usedSigns and symptoms
Arlt et al42 2007CT myelogramGadopentetate dimeglumine
20 mL
7 µmol/g brain‡, ¶
Confusion, nausea, vomiting, dysarthria, somnolence, blurred vision, delirium, limb ataxia, gaze-evoked nystagmus, aggressive behavior, visual and auditory hallucination, incomplete anterograde amnesia
Li et al62 2008MRI myelographyGadopentetate dimeglumine
15 mL
5.35 µmol/g brain‡, ¶
Headache, nausea, vomiting, coma, systemic seizures
Kapoor et al63 2010Epidural steroid injectionGadodiamide
4+4 mL
2.86 µmol/g brain‡
Mental status changes, grand-mal seizure, respiratory distress, agitation, hyperglycemia, sinus tachycardia, respiratory acidosis, metabolic alkalosis, amnesia
Park et al64 2010CT myelogramGadopentetate dimeglumine
6 mL
2.14 µmol/g brain‡, ¶
Confusion, global aphasia, vomiting, stupor, severe rigidity, intermittent seizures, fever, high blood pressure
Nayak et al65 2013Administered through side port of an intraventricular catheterGadopentetate dimeglumine
10 mL
3.57 µmol/g brain‡
Agitation, labile blood pressure, aphasia, dysarthria, depressed mentation, right facial group, increased urine output
Samardzic66 2015Epidural steroid injectionGadodiamide
4 mL
1.43 µmol/g brain‡
Nausea, dyspnea, altered mental status
Singh et al67 2016Accidentally delivered through an intrathecal drainGadopentetate dimeglumine
10 mL§
3.57 µmol/g brain‡, ¶
Aphasia, facial group, delirium, intubation, status epilepticus, coma, permanent impairment
Reeves et al68 2017Intrathecal catheter contrast studyGadobutrol
2 mL
1.43 µmol/g brain
Severe spastic pain, spasms in lower extremities
Popescu et al43 2017L4-L5 interlaminar epidural steroid injectionGadobutrol
1.5 mL
1.07 µmol/g brain‡
Vomiting, seizure activity, impaired consciousness and respiratory compromise requiring intubation
Pokersnik69 2018Intrathecal pain pump evaluationNot statedConfusion, aphasia
Provenzano 44 2019Minimally invasive lumbar decompressionGadoteridol
5 mL
2.3 µmol/g brain‡
Seizure, mental status changes, severe headache, apnea, agitation, fever, increased muscle tone, eye and tongue twitching, wide-complex pulseless tachycardia, multisystem organ failure, death
Besteher et al70 2019MR myelography to identify CSF leakGadobutrol
2 mL in 20 mL NaCl 0.9%
1.43 µmol/g brain
Severe sacral pain, uncontrolled defecation, nausea, vomiting, agitation, intubation, cardiac arrythmia
Calvo et al71 2020Cervical myelographyGadobutrol
12 mL
8.6 µmol/g brain‡
Nausea, emesis, seizure, apnea, coma
Platt et al72 2020Lumber epidural steroid injectionGadobutrol
2 mL
1.43 µmol/g brain
Altered mental status, right gaze deviation, upper extremity tonic posturing
Malalur73 2020CT myelogramGadopentetate dimeglumine
12 mL
4.29 µmol/g brain
Bilateral hearing loss, altered mental status, somnolence
Patel et al49 2021Diagnostic myelogram evaluating intrathecal pain pump malfunctionNot statedConfusion, aphasia, binocular diplopia, tinnitus, headache, fatigue
Moradian74 2022L5-S1 interlaminar epidural steroid injectionGadodiamide
4 mL
1.43 µmol/g brain
Vomiting, altered mental status, hypertension, hypoxia
  • *Adapted from Provenzano et al.44

  • †In this column, volume of GBCA administered is provided alongside the estimated concentration of gadolinium per gram of brain. Calculated using 1400 g as the average weight of the human brain to be consistent with calculations from Arlt et al.42

  • ‡Intrathecal administration was unintentional.

  • §Calculated based on values from Patel et al.49

  • ¶Unintentional intrathecal administration was due to drug error.

  • CSF, cerebral spinal fluid; GBCA, gadolinium-based contrast agent.