Status Epilepticus after Mye lography with Inadve rtent Injection of Diatrizoate

A 37-year-old male patient was transferred from a local orthopedic clinic due to status epilepticus following a myelography with diatrizoate. On his laboratory findings, metabolic acidosis was prominent. Non-enhanced brain CT scan showed a high densinty in the subarchnoid space. With careful respiratory support, hydration, correction of acid-base balance, administration of dexamethasone, and anticonvulsant therapy, he completely recovered after 3 days. Diatrizoate is an ionic, iodinated and hyperosmolar X-ray contrast medium. It must not be injected intrathecally because of the risk to the central nervous system. The possible mechanisms are anaphylactic reaction due to iodine hypersensitivity, hyperosmolar effect, and direct chemotoxicity by ionicity and chemical structure itself.

Incomplete AICA Syndrome Presented with Peripheral Facial Palsy; A Variant of Gasperini Syndrome

Acute infarcts of the anterior inferior cerebellar artery (AICA) territory are unusual. Furthermore incomplete AICA infarcts are perplexing because of its variations of vascular anatomy and inconsistent clinical features. We present a case with clinical features of AICA infarction, which consist of ipsilateral peripheral-type facial palsy, vertigo, and contralateral facial and upper limb sensory changes without motor weakness. The patient had hypertension and was a current smoker. The high signal intensity on inferior pontine tegmental area was found on MRI and the R2 interneuronal dysfunction was note on Blink reflex. The angiographic findings didn't show any focal vascular lesions, which is contrary to the pathogenesis of AICA infarction published previously. On the clinical ground, the present case reserves to attention in that patients with peripheral-type facial palsy should be properly evaluated and with thorough neurological examination and we could differentiate between the incomplete AICA infarcts such as Gasperini syndrome and Bell's palsy.