1677 NEUROTOXIC COMPLICATIONS OF CONTRAST CT IN CHILDREN

Abstract

Computed cranial tomography (CT) has been considered a safe and accurate method for studying intracranial lesions in children. As a diagnostic adjunct, radiographic contrast material is administered intravenously (IV) to enhance and further characterize lesions such as vascular malformations. Traditional ionic contrast agents can penetrate the blood brain barrier (BBB) and exert an adverse effect due to hyperosmolality, lipid solubility and neurotoxic properties when administered intra-arterially. Contrast agents given IV are generally considered non-neurotoxic.

We report 3 children with brain tumors who rapidly deteriorated following CT with infusion. All had evidence of papilledema but were alert and responsive prior to CT. A patient dose of 2-2.5 ml/kg IV Renografin-60 (diatrizoate meglumine 52% and diatrizoate sodium 8%) was used. Within 6 to 8 hours each child showed progressive lethargy, disorientation, bradycardia, hypertension and generalized seizures (2).

Zamani showed that 4ml/kg IV diatrizoate meglumine-60 disrupted the BBBin some normal dogs. Focal seizures have recently been reported in adults with cerebral metastases following contrast CT. It is likely that the neurological deterioration in the reported children resulted from the osmotic effects of contrast material on cerebral tissue. As contrast enhanced CT may produce grave neurological complications in children with brain tumors, the study should be reserved for those where the probability of additional significant diagnostic yield exists.

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