Brain pentopaque remnants

Case contributed by David Puyó

Presentation

History of ischemic stroke in right ACM 1 year ago, high blood pressure. History of surgery for lumbar intervertebral disc herniation 40 years ago. CT scan for control of stroke.

Patient Data

Age: 75 years
Gender: Male
CT

CT Brain

There are multiple small foci of hyperattenuating material scattered into 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 metal density and are generating streark artifacts. 

Case Discussion

Pantopaque was an oil-based contrast medium 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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Case information

rID: 78403
Published: 4th Jun 2020
Last edited: 30th Jun 2020
Inclusion in quiz mode: Included
Institution: Hospital de Talagante

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