Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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A Case of Myelopathy after Intrathecal Injection of Fluorescein

  • Park, Kwang-Yeol (Department of Neurology College of Medicine Chung-Ang University) ;
  • Kim, Young-Baeg (Department of Neurosurgery College of Medicine Chung-Ang University)
  • Published : 2007.12.28
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Abstract

We present a case with seizure, confusion, hypesthesia and paraplegia after intrathecal injection of fluorescein. A 41-year-old man was admitted to our institution for the management of the CSF leakage. Intrathecal injection of fluorescein was performed and he complained of severe pain and numbness in the lower extremities at the end of the injection. Four hours later, he exhibited confusion, paraparesis and two episodes of generalized seizures. Two days later, he showed paraplegia and all sensory modalities below the T12 level were absent. Spine magnetic resonance imaging revealed myelopathic change in the lower thoracic spinal cord. There was no improvement of weakness and sensory deficits in lower extremity even 14 days after fluorescein injection. We speculated that thoracic myelopathy was associated with the intrathecal injection of fluorescein. In spite of its rarity, the complication after intrathecal injection of fluorescein could be serious. Thus, obtaining an informed consent with discussion with patient before the procedure is mandatory.

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References

  1. Anari S, Waldron M, Carrie S : Delayed absence seizure : A complication of intrathecal fluorescein injection A case report and literature review. Auris Nasus Larynx 34 : 515-518, 2007 https://doi.org/10.1016/j.anl.2006.09.012
  2. Coeytaux A, Reverdin A, Jallon P, Nahorv A : Non convulsive status epilepticus following intrathecal fluorescein injection. Acta Neurol Scand 100 : 278-280, 1999 https://doi.org/10.1111/j.1600-0404.1999.tb00395.x
  3. Guimaraes R, Becker H : A new technique for the use of intrathecal fluorescein in the repair of cerebrospinal fluid rhinorrhea using a hypodense diluent. Rev Laryngol Otol Rhinol (Bord) 122 : 191-193, 2001
  4. Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J : Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea : a meta-analysis. Laryngoscope 110 : 1166-1172, 2000 https://doi.org/10.1097/00005537-200007000-00019
  5. Keerl R, Weber RK, Draf W, Wienke A, Schaefer SD : Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas : an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope 114 : 266-272, 2004 https://doi.org/10.1097/00005537-200402000-00016
  6. Kirchner FR : Use of fluorescein for the diagnosis and localization of cerebrospinal fluid fistulas. Surg Forum 12 : 406-408, 1961
  7. Kirchner FR, Proud GO : Method for the identification and localization of cerebrospinal fluid, rhinorrhea and otorrhea. Laryngoscope 70 : 921-931, 1960
  8. Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P : Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks : nine-year experience. Neurosurgery 58 : ONS-246-256; discussion ONS-256-257, 2006
  9. Mahaley MS Jr, Odom GL : Complication following intrathecal injection of fluorescein. J Neurosurg 25 : 298-299, 1966 https://doi.org/10.3171/jns.1966.25.3.0298
  10. Moseley JI, Carton CA, Stern WE : Spectrum of complications in the use of intrathecal fluorescein. J Neurosurg 48 : 765-767, 1978 https://doi.org/10.3171/jns.1978.48.5.0765
  11. Placantonakis DG, Tabaee A, Anand VK, Hiltzik D, Schwartz, TH : Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery 61 : 161-165; discussion 165-166, 2007 https://doi.org/10.1227/01.neu.0000289729.20083.dc
  12. Tabaee A, Placantonakis DG, Schwartz TH, Anand VK : Intrathecal fluorescein in endoscopic skull base surgery. Otolaryngol Head Neck Surg 137 : 316-320, 2007 https://doi.org/10.1016/j.otohns.2006.11.012
  13. Wallace JD, Weintraub MI, Mattson RH, Rosnagle R : Status epilepticus as a complication of intrathecal fluorescein. Case report. J Neurosurg 36 : 659-660, 1972 https://doi.org/10.3171/jns.1972.36.5.0659