FATAL REACTION FROM INADVERTENT INTRATHECAL ENTRY OF IONIC CONTRAST-MEDIUM DURING A NEPHROGRAM

A fatal case of inadvertent intrathecal entry of an ionic contrast med ium during a nephrogram is reported. The patient developed seizures an d failed to regain consciousness following the event, Computerized tom ography revealed extensive intraventricular and subarachnoid hyperdens ity and cerebrospinal fluid analysis revealed markedly elevated protei n content. At autopsy a traumatic communication between the kidney and thecal sac was identified, Histopathological examination revealed cyt oplasmic shrinkage and eosinophilia, nuclear pyknosis and karyorrhexis in neocortical neurons. Central chromatolysis was seen in brain stem motor nuclei and anterior horn cell neurons. The neuropathological fin dings appear to be on the basis of direct neurotoxicity from the contr ast medium and excitotoxic injury secondary to seizure activity. Inadv ertent intrathecal administration of ionic contrast media is a rare oc currence with often fatal consequences despite aggressive medical mana gement.