Author | Procedure | GBCA† dose used | Signs and symptoms |
Arlt et al42 2007 | CT myelogram | Gadopentetate 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 2008 | MRI myelography | Gadopentetate dimeglumine 15 mL 5.35 µmol/g brain‡, ¶ | Headache, nausea, vomiting, coma, systemic seizures |
Kapoor et al63 2010 | Epidural steroid injection | Gadodiamide 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 2010 | CT myelogram | Gadopentetate dimeglumine 6 mL 2.14 µmol/g brain‡, ¶ | Confusion, global aphasia, vomiting, stupor, severe rigidity, intermittent seizures, fever, high blood pressure |
Nayak et al65 2013 | Administered through side port of an intraventricular catheter | Gadopentetate dimeglumine 10 mL 3.57 µmol/g brain‡ | Agitation, labile blood pressure, aphasia, dysarthria, depressed mentation, right facial group, increased urine output |
Samardzic66 2015 | Epidural steroid injection | Gadodiamide 4 mL 1.43 µmol/g brain‡ | Nausea, dyspnea, altered mental status |
Singh et al67 2016 | Accidentally delivered through an intrathecal drain | Gadopentetate dimeglumine 10 mL§ 3.57 µmol/g brain‡, ¶ | Aphasia, facial group, delirium, intubation, status epilepticus, coma, permanent impairment |
Reeves et al68 2017 | Intrathecal catheter contrast study | Gadobutrol 2 mL 1.43 µmol/g brain | Severe spastic pain, spasms in lower extremities |
Popescu et al43 2017 | L4-L5 interlaminar epidural steroid injection | Gadobutrol 1.5 mL 1.07 µmol/g brain‡ | Vomiting, seizure activity, impaired consciousness and respiratory compromise requiring intubation |
Pokersnik69 2018 | Intrathecal pain pump evaluation | Not stated | Confusion, aphasia |
Provenzano 44 2019 | Minimally invasive lumbar decompression | Gadoteridol 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 2019 | MR myelography to identify CSF leak | Gadobutrol 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 2020 | Cervical myelography | Gadobutrol 12 mL 8.6 µmol/g brain‡ | Nausea, emesis, seizure, apnea, coma |
Platt et al72 2020 | Lumber epidural steroid injection | Gadobutrol 2 mL 1.43 µmol/g brain | Altered mental status, right gaze deviation, upper extremity tonic posturing |
Malalur73 2020 | CT myelogram | Gadopentetate dimeglumine 12 mL 4.29 µmol/g brain | Bilateral hearing loss, altered mental status, somnolence |
Patel et al49 2021 | Diagnostic myelogram evaluating intrathecal pain pump malfunction | Not stated | Confusion, aphasia, binocular diplopia, tinnitus, headache, fatigue |
Moradian74 2022 | L5-S1 interlaminar epidural steroid injection | Gadodiamide 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.