Abstract 108: Iatrogenic Intrathecal Gadolinium Contrast Administration During Spinal Pain Procedures Mimicking Subarachnoid Hemorrhage: Two Case Reports

Gadolinium‐based contrast agents (GBCAs) are sometimes used off‐label as alternatives to iodine‐based contrast agents for visualization during interventional spinal pain procedures in individuals with known hypersensitivity reactions to iodine. The administration of GBCAs into neuraxial space (i.e. epidural and intrathecal areas) is not FDA approved. When administered intrathecally, blood‐brain barrier does not play a role and contrast passes from the pial surfaces into brain parenchyma by simple diffusion leading to neurotoxicity. The adverse effects range from headaches, encephalopathy, seizures, ataxia, confusion to even death. We report two cases of severe GBCA toxicity after its accidental intrathecal administration during spinal procedures.