Intrathecal iodinated contrast-induced transient spinal shock

BMJ Case Rep. 2020 Dec 21;13(12):e237610. doi: 10.1136/bcr-2020-237610.

Abstract

Transient spinal shock is a previously unreported complication of intrathecal contrast. A 63-year-old man presented with the chief complaint of worsening back pain. Computed topography of lumbar spine without contrast showed a lytic lesion. After international normalized ratio (INR) correction, patient was sent for CT myelogram. After intrathecal contrast injection, the patient dropped his blood pressure profoundly and developed clinical manifestations of spinal shock. Emergent intravenous bolus fluids were initiated resulting in improvement in blood pressure. Patient's spinal shock resolved within hours. CT myelogram was normal except previously known lytic lesion. It was concluded that the transient shock was most likely due to contrast injection. We believe that this is the first reported case of transient spinal shock following CT myelogram using water-soluble iodinated non-ionic contrast agent administered intrathecally.

Keywords: adult intensive care; contraindications and precautions; neuroimaging; spinal cord; unwanted effects / adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Back Pain / diagnosis*
  • Contrast Media / administration & dosage
  • Contrast Media / adverse effects*
  • Humans
  • Injections, Spinal / adverse effects*
  • Iohexol / administration & dosage
  • Iohexol / adverse effects
  • Male
  • Middle Aged
  • Myelography / adverse effects*
  • Myelography / methods
  • Remission, Spontaneous
  • Shock / chemically induced*
  • Spinal Cord / drug effects*
  • Spinal Cord / physiopathology
  • Tomography, X-Ray Computed

Substances

  • Contrast Media
  • Iohexol