Inadvertent use of ionic contrast material in myelography: case report and management guidelines.
Inadvertent use of ionic contrast material in myelography: case report and management guidelines.
复制标题
脊髓造影中离子造影剂的无意使用：病例报告和管理指南。
DOI：
10.1227/00006123-199502000-00027
复制
发表时间：
1995
期刊：
影响因子：
4.8
通讯作者：
D. N. Pippins
中科院分区：
文献类型：
--
作者：
E. Rivera;M. Hardjasudarma;B. Willis;D. N. Pippins
A 38-year-old man with chronic low back pain underwent myelography and was inadvertently injected with ionic contrast medium. Within minutes, he started complaining of muscle spasms in his lower extremities, followed by respiratory distress and myoclonus. Immediate intravenous treatment with fluids, antihistamines, and supplemental oxygen was started. Within 1 hour after the myelogram, he was intubated and paralyzed with a neuromuscular blocking agent. Shortly thereafter, he began receiving triple anticonvulsant therapy and a lumbar drain was inserted to allow for the evacuation of cerebrospinal fluid. Electroencephalographic monitoring, which initially showed that the patient was in status epilepticus, subsequently showed no more episodes of seizure activity. Massive rhabdomyolysis, renal failure, and metabolic derangement were prevented. He was then extubated and regained full consciousness. He was discharged on the 13th day of hospitalization with mild amnesia and some cognitive dysfunction. A review of the literature reveals descriptions of 9 of 15 patients who survived similar episodes. We conclude that prompt identification of the contrast medium error and prompt intervention are crucial to increase significantly the chances of survival. Elective paralysis, anticonvulsant therapy, and cerebrospinal fluid drainage are the recommended modes of treatment.
