Previous cases of intrathecal gadolinium neurotoxicity
| Author | Procedure | GBCA* dose used | Signs and symptoms | Outcome |
| 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.