A Case Report: Malignant Cerebral Edema as an Anaphylactic Reaction to Intrathecal Contrast from CT Myelography
Omolara Kolawole1, Jorge Patino Murillas3, Sri Raghav Sista2
1Neurology, University of Texas Health Science Centre at Houston, 2University of Texas Health Science Centre at Houston, 3The University of Texas Health Science Center at Houston McGovern Medical School
Background:
The neurotoxic complications of intrathecal contrast administration comprise a range of manifestations including headaches, intracranial hemorrhage, encephalopathy, aseptic meningoencephalitis and seizures. In this report, we highlight an exceedingly rare occurrence of malignant cerebral edema with concomitant obstructive hydrocephalus as a complication, which has been scarcely documented in the literature.
Results:
A 59-year-old woman with intractable epilepsy, degenerative disc disease presented with one day of altered mentation. Examination on arrival was limited to decreased arousal, orientation to self, antigravity in all limbs but quickly progressed to obtundation. Non-contrast CT brain showed diffuse cerebral edema with poor gray-white differentiation and effacement of basal cisterns. Later, it was learnt that she underwent CT myelogram lumbar spine with iohexol, a few hours prior to the symptom onset. Raising head-of-bed, intubation with hyperventilation, hypertonic saline and extra ventricular drain placement were undertaken. The rest of the work up including electroencephalogram and MRI Brain was non-contributory. Spontaneous recovery to pre-admission baseline, which was also reflected in the repeat neuroimaging was achieved within a day without any further interventions.
Conclusions:
Malignant cerebral edema as a delayed anaphylactic reaction to iohexol, a non-ionic contrast agent represents an exceptionally rare phenomenon that demands immediate recognition and swift implementation of symptomatic management, potentially leading to favorable patient outcomes.