Table 1

Previous cases of intrathecal gadolinium neurotoxicity

AuthorProcedureGBCA* dose usedSigns and symptomsOutcome
Arlt et al 17 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 and incomplete anterograde amnesia.Day 4: regained alertness
Day 7: resolved behavioral disturbances and psychotic symptoms
Day 10: discharged
Day 56: persistent concentration difficulties
Li et al 18 MRI myelography.Gadopentetate dimeglumine
15 mL
5.35 µmol/g brain.†‡
Headache, nausea, vomiting, coma and systemic seizures.Day 8: regained consciousness
Day 22: discharged
Day 60: no reported side effects
Kapoor et al 19 Epidural steroid injection.Gadodiamide
4 mL
1.43 µmol/g brain.†
Mental status changes, grand-mal seizure, respiratory distress, agitation, hyperglycemia, sinus tachycardia, respiratory acidosis, metabolic alkalosis and amnesia.Day 8: responded to verbal commands and improved pulmonary function
Day 10: discharged
Day 182 (6 months): complained of partial seizure-like activity
Park et al 20 CT myelogram.Gadopentetate dimeglumine
6 mL
2.14 µmol/g brain.†‡
Confusion, global aphasia, vomiting, stupor, severe rigidity, intermittent seizures, fever and high blood pressure.Day 4: improved cognition
Day 15: discharged
1 month: complained of visual disturbances
Nayak et al 16 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 droop and increased urine output.Day 5: performed lumbar CSF drain
Day 26: required a tracheostomy for ventilatory support
2 months: still in intensive care. Resolution of the intraventricular GBCA
Reeves et al 21 Intrathecal catheter contrast study.Gadobutrol
2 mL
1.43 µmol/g brain.
Severe spastic pain and spasms in lower extremities.Day 28: no sequelae
Popescu et al 12 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.Day 1: extubated and made full recovery
  • *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 in order to be consistent with calculations from Arlt et al. 17

  • †Intrathecal administration was unintentional.

  • ‡Unintentional intrathecal administration was due to drug error.

  • GBCA, gadolinium-based contrast agent.