Acute Encephalopathy and Cardiac Arrest Induced by Intrathecal Gadolinium Administration

  • Bianca BesteherEmail author
  • Ha-Yeun Chung
  • Thomas E. Mayer
  • Otto W. Witte
  • Klaus Kirchhof
  • Matthias Schwab


Intravenously applied gadolinium-based contrast agents (GBCA) are widely used for magnetic resonance imaging (MRI) diagnostics in all clinical disciplines. They are considered safe with overall rates of less than 2.4% of acute allergic and non-allergic reactions [1]. Severe adverse effects, such as cardiac arrest [2] occur in 0.0–0.03% when administered in commonly used dosages. Intrathecal use of GBCA has been used off-label for several indications, especially for diagnosis of cerebrospinal fluid (CSF) leaks and is mostly well-tolerated [3]. This article reports an unusual case with acute onset encephalopathy and cardiac arrest following diagnostic intrathecal administration of gadobutrol.

Case Presentation

A 69-year-old Caucasian female was admitted to the neurological unit with repetitive severe (visual analogue scale, VAS 7/10), bitemporal headaches lasting minutes after coughing, pressing or lifting heavy objects. Symptom onset had been 12 months earlier following...


Compliance with ethical guidelines

Conflict of interest

B. Besteher, H.-Y. Chung, T.E. Mayer, O.W. Witte, K. Kirchhof and M. Schwab declare that they have no competing interests.

Ethical standards

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the patient included in this report.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyJena University HospitalJenaGermany
  2. 2.Department of Psychiatry and PsychotherapyJena University HospitalJenaGermany
  3. 3.Department of NeuroradiologyJena University HospitalJenaGermany

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