Brain Pantopaque remnants

Case contributed by David Puyó
Diagnosis certain


History of ischemic stroke in right MCA territory 1 year ago and high blood pressure. History of surgery for lumbar intervertebral disc herniation 40 years ago. CT scan for stroke.

Patient Data

Age: 75 years
Gender: Male

CT Brain


There are multiple small foci of hyperattenuating material scattered in the CSF circulation spaces at the skull base (extra-axial) and multiple small intrathecal hyperdensities of varying sizes are seen along the length of the spinal cervical canal. Also, the brain parenchyma shows sequela of a previous right MCA region infarct. 

Annotated image

The hyperattenuating material has metallic density and is generating streak artifacts. 

Case Discussion

Pantopaque (a.k.a. Myodil) was an oil-based contrast medium (generic name: iofendylate) that was previously used for myelography. Since 1944, Pantopaque was apparently the most popular intrathecal agent, as it obtained good image reproduction with contrast between the different intrathecal elements; however it was soon found to cause arachnoiditis, but was kept in clinical use until 1986 when the FDA finally banned its sale in the US due to its slow elimination (1 mL/year) and its high osmolarity.

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