Intracranial accumulation of contrast agent after myelography

Case contributed by Dr Anna Klempka

Presentation

Mild headache and general weakness resolved within 24 hours.

Patient Data

Age: 85 years
Gender: Female

Diffuse hyperdense opacities in subarachnoid space. There is some gradiation of the hyperdensities, between 80-180HU. The lateral ventricles, as well as the third and fourth ventricle, are free of hyperdensity.

An additional finding: a calcified structure on the right sphenoid bone (between the greater wing and sphenoid body) with a diameter of approximately 10 mm and a small calcification right on the frontal bone, both were identified as calcified meningiomas.

On the follow-up MRI, there are no signs of hemorrhage or ischemic stroke.

Case Discussion

This patient underwent a CT-myelography the day before the CT scan. The postinterventional symptoms such as headache, nausea and sometimes confusion are caused due to neurotoxicity of the intrathecal administrated iodinated contrast agent. All clinical symptoms reverse after 24 hours. There were no clinical symptoms of global subarachnoid hemorrhage. 

During the myelography, an iodinated contrast medium was intrathecally injected under fluoroscopic guidance. The physiological circulation of the spinal and cerebral fluid caused the appearance of accumulated hyperdense opacities in the subarachnoid space in almost all intracranial localizations. There is some gradation of the hyperdensities (reducing in time from approximately 300HU), which is different from a subarachnoid hemorrhage. The patient was discharged without any clinical symptoms a few days after the examination. Myelography was recommended to examine the spinal space after a long spinal fusion and a new onset of radicular symptoms. The MRI, as well as a non-contrast CT, were contra-indicated because of metal-related artefacts due to instrumented spine. 

This case was published with support and agreement of Ch. Pöckler- Schöniger MD, Head of Department of Radiology and Neuroradiology, SRH Karlsbad- Langensteinbach, Germany 

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Case information

rID: 66122
Published: 28th Feb 2019
Last edited: 1st Mar 2019
Inclusion in quiz mode: Included
Excluded from licensing
Institution: Departmet of Radiology and Neuroradiology, SRH Klinikum Karlsbad Langensteinbach, Germay

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