INADVERTENT USE OF IONIC CONTRAST MATERIAL IN MYELOGRAPHY - CASE-REPORT AND MANAGEMENT GUIDELINES

A 38-YEAR-OLD MAN with chronic low back pain underwent myelography and was inadvertently injected with ionic contrast medium. Within minutes , he started complaining of muscle spasms in his lower extremities, fo llowed by respiratory distress and myoclonus. Immediate intravenous tr eatment with fluids, antihistamines, and supplemental oxygen was start ed. Within 1 hour after the myelogram, he was intubated and paralyzed with a neuromuscular blocking agent. Shortly thereafter, he began rece iving triple anticonvulsant therapy and a lumbar drain was inserted to allow for the evacuation of cerebrospinal fluid. Electroencephalograp hic monitoring, which initially showed that the patient was in status epilepticus, subsequently showed no more episodes of seizure activity. Massive rhabdomyolysis, renal failure, and metabolic derangement were prevented. He was then extubated and regained full consciousness. He was discharged on the 13th day of hospitalization with mild amnesia an d some cognitive dysfunction. A review of the literature reveals descr iptions of 9 of 15 patients who survived similar episodes. We conclude that prompt identification of the contrast medium error and prompt in tervention are crucial to increase significantly the chances of surviv al. Elective paralysis, anticonvulsant therapy, and cerebrospinal flui d drainage are the recommended modes of treatment.