Intrathecal iodinated contrast-induced transient spinal shock

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.

Spinal Shock: Clinical Pearls

“…Resuscitation, hemodynamic stabilization, and clinical assessment of a patient with spinal shock are a simultaneous and ongoing process [4,8]. Clinical details include a detailed history of the mode and mechanism of injury (hit by another vehicle, fall, rollover crash, ejection outside the car, or seat belt was used or not), any history of alcohol intoxication, history of any comorbid conditions, and a detailed spine and physical examination of all the systems to exclude any associated injuries or dysfunctions [14]. Neurological examination includes assessment of the level of consciousness, motor and sensory functions, and assessment of deep tendon and superficial reflexes [15][16][17].…”