Intraventricular Gadoteric Acid Intoxication: First Report.

BACKGROUND: Gadolinium-based contrast agents are relatively safe for use in magnetic resonance imaging (MRI) of nervous system pathology. Few reports have been reported regarding the severe adverse effects. These are mostly mild anaphylactoid reactions, especially in the vulnerable group. CASE DESCRIPTION: We report a case of an adverse effect of gadoteric acid concerning the misuse as intraventricular administration. To our knowledge, this is the first report related to intraventricular spillage and its results. A 38-year-old male patient with a complaint of headache and drowsiness was admitted to the hospital, after which cranial MRI revealed that he had a posterior fossa mass. An operation was performed with the catheterization of the lateral ventricule as a safety device at the beginning, and later mass was evacuated gross totally. Frozen pathology result showed the tumor was medulloblastoma. On the first postoperative day a control contrasted cranial and total spinal MRI was planned. He was observed to have a tonic-clonic generalized seizure soon after returning to the ward. After giving the acute management with antiepileptics, the patient was stabilized and it was recognized that the patient was administered contrast media by the intraventricular route. Symptomatic treatment and cerebrospinal fluid irrigation by external ventricular drainage helped the patient's improvement. After a week his symptoms were relieved and he had no complications during outpatient controls. CONCLUSIONS: In addition to formal basic supportive treatment, cerebrospinal fluid irrigation of the toxic contrast material is the best management method in case of such an unexpected misadministration of gadoteric acid.

What do we know about ALARA? Is our knowledge sufficient about radiation safety?

BACKGROUND: The aim of this study was to determine the knowledge of neurosurgeons and emergency physicians about ALARA (as low as reasonably achievable) and to gain awareness to them about this topic. METHODS: A multiple-choice survey comprising 17 questions was performed to 30 neurosurgeons and 70 emergency room doctors. RESULTS: Emergency medicine doctors, neurosurgeons, emergency medicine residents, neurosurgery residents and general practitioners participated in the survey. Sixty-six percent of participants stated that they examined more than 50 patient with headache, dizziness and head trauma in emergency service per diem and more than half of the participants stated that brain CT was performed in the event of patient's request, even if there was not an indication. 75% of the participants stated that they requested CT scan without neurological examination when the number of patients increased in the emergency room. Eighty-three percent of the participants did not think there was a safe dose limit in CT, 92% did not know the radiation dose received during brain CT, 96% did not know the meaning of the ALARA. Fifty-seven percent of the participants stated that if they informed about the criteria of ALARA, they will take into acount these criteria while requesting CT scan. CONCLUSIONS: In our country, doctors working in emergency services request brain CT needlessly because of taking into account the patient's wish and fear of malpractice. The knowledge of the neurosurgeons and emergency service doctors about ALARA is insufficient. It is necessary to educate our physicians about ALARA protocol, for taking these criteria into their consideration when requesting CT examination. For protecting the patients from the effects of ionizing radiation and reducing the economic loss of hospitals, it is necessary to increase awareness of the ALARA protocol and to increase the number of hospitals which protocol is applied.