Gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) is the main contrast agent used in MRI, known for its good tolerance and rare toxicity. Even intrathecal injection of limited doses of Gadolinium can be performed in some indications. To our knowledge, only 3cases of accidental intraventricular injection of Gadolinium have been yet reported in the literature. We report the case of a 40-year-old male patient, who presented with headaches and vomiting. Brain MRI showed a right parietal abscess. The patient underwent emergent surgery for drainage of the septic collection. Postoperative MRI showed the development of a hydrocephalus related to a ventriculitis. Another surgery was performed to set up an external ventricular shunt, which lead to an improvement of the neurological status. A control brain MRI was scheduled for the patient, which revealed extensive abnormal enhancement inside the right lateral ventricle, on the basal cisterns as well as a leptomeningeal enhancement. Shortly after Gadolinium injection, the patient presented a tonic-clonic seizure. This clinico-radiological context leads to discover of the inadvertent intraventricular administration. Afterward, the patient's condition quickly deteriorated. Two days after the MRI he presented a cardiorespiratory arrest followed by death. Direct administration of Gadolinium into a ventriculostomy mistaken for intravenous catheter is a rare but harmful situation. Despite their rarity, such cases prove the importance of tracing all lines to their insertion sites to be confident of their appropriateness for injection.

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IntroductionParkinson’s disease (PD) is a chronic, neurodegenerative disorder leading to dopamine deficiency. Phenotypically, there is a wide spectrum of motor and non-motor symptoms (NMS). Among NMS, sexual dysfunction (SD) is one of the most disabling and crippling symptom. However, SD are usually neglected and underdiagnosed in PD patients.ObjectivesOur study aimed to estimate the effect of motor disability and the disease course on sexual dysfunction in PD patients.MethodsThis retrospective study included 42 patients (18 males and 24 females) from the department of neurology of the National Institute of Neurology Mongi Ben Hmida in Tunis, Tunisia, diagnosed with PD between 1999 and 2022. The diagnosis of PD was confirmed according to the Movement Disorder Society (MDS) diagnostic criteria of PD. The MDS Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor was used to estimate motor disability and Hoehn and Yahr (H&Y) stage was used to rate disease severity. The SD of PD patients was measured by applying the sexual items of Scales for Outcomes in Parkinson’s Disease - Autonomic Dysfunction (SCOPA-AUT).ResultsSD was observed in only 11 patients (26.2%) with a sex-ratio of M/F = 1.2 and a mean age of 52 (between 40 and 72). The mean age of PD onset was 47. According to the MDS-UPDRS part III, 1 patient had a severe motor disorder (MDS-UPDRS> 59), and according to the H&Y scale, no patient had a severe stage of the disease. Nine patients had motor complications such as motor fluctuations and L-Dopa induced dyskinesia.The SD described by our patients were: women reported Vaginal Dryness (4 patients), with difficulties reaching an orgasm (3 patients); men reported erectile dysfunction (6 patients), and difficulties in reaching an orgasm (6 patients). Among these patients, 3 were treated for SD with Tadalafil (all males).In our study, no significant gender-related differences were found in scores related to SD in patients with PD. Neither the disease severity nor the motor disability was significantly associated to sexual disorders (respectively p=0.26 and p=0.12). Also, Motor complications induced by L-Dopa medication, assessed by the part IV of MDS-UPDRS scale, had no significant effect in the occurrence of SD in PD (p=0.78).ConclusionsSexual behavior has neuronal and hormonal modulation. Lack of dopamine seems to have an important role in the development of SD. However, it occurs independently of the disease severity and the motor disability. Thus, clinicians should be aware of the importance of assessing and treating such symptoms since the beginning of the disease.Disclosure of InterestNone Declared