Excretion of Aqueous Myelographic Contrast Media in Animals Undergoing a Repeat Myelogram

Op, Eldevik; Haughton, V M; Ea, Sasse; Kc, Ho

doi:10.1097/00004424-198011000-00008

Cited by 4 publications

(1 citation statement)

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“…There is a considerable distance between the intracranial cistern and lumbar subarachnoid space, and the heavy contrast medium settles into lower lesions through gravity [12]. Indeed, experimental results indicate that contrast media are normally eliminated directly from the lumbar subarachnoid space into the vascular circulation without significant accumulation in the intracranial cisterns [13,14]. We believe that our patient’s position in the recovery room and his high blood pressure may have contributed to this rare complication after L-PEN.…”

Section: Discussionmentioning

confidence: 99%

Contrast mimicking a subarachnoid hemorrhage after lumbar percutaneous epidural neuroplasty: a case report

Oh¹,

An²,

Choi³

et al. 2013

J Med Case Reports

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IntroductionSubarachnoid hemorrhage is one of the most feared acute neurologic events. Accurate diagnosis of subarachnoid hemorrhage is essential, and computed tomography of the brain is the first diagnostic imaging study. However, in rare circumstances, a similar appearance may occur in the absence of blood in the subarachnoid space. The contrast enhancement of subarachnoid space is a rare complication after lumbar percutaneous epidural neuroplasty, with, to the best of our knowledge, no previous report in the literature.Case presentationA 42-year-old Korean male patient, who underwent a spinal operation five years previously at the level of L4 to S1, visited our clinic with persistent and aggravating low back pain. An imaging study revealed the focal and diffuse disc protrusion at the level of L4/5 and L5/S1. The clinician decided to perform a lumbar percutaneous epidural neuroplasty. During the procedure, dural adhesion was suspected at the previously operated level, and the neuroplasty catheter was malpositioned into the intradural space on the first attempt. After the catheter was repositioned, the scheduled epidural neuroplasty was completed. Our patient had no definite abnormal neurological signs. But, after a day, our patient complained of severe headache with sustained high blood pressure without neurological disorientation. Computed tomography of his brain showed a subarachnoid hemorrhage-like appearance with intracranial air. Sequential angiography, subtractional magnetic resonance imaging and examination of the cerebrospinal fluid revealed no abnormalities. Follow-up computed tomography after one day revealed no definite intracranial hemorrhage, and our patient was discharged with improved low back pain without neurological deficit.ConclusionWe report a rare case of contrast mimicking a subarachnoid hemorrhage after lumbar percutaneous epidural neuroplasty. The physician should keep in mind a rare case like this, and the supine position with head elevation is necessary to avoid a similar complication after lumbar percutaneous epidural neuroplasty.

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Section: Discussionmentioning

confidence: 99%