![]() ![]() After transfer to the ER department, her systolic blood pressure dropped to 60 mm Hg, and 0.1 mg of 1:10000 epinephrine was administered via the intravenous route. The patient was transferred promptly to the emergency room under close monitoring. Her blood pressure remained at 90/50 mm Hg with O 2 saturation of 95% eighteen minutes after the injection. Considering the marginal range of blood pressure, 4 mg of chlorpheniramine was administered. Her blood pressure dropped from the baseline level of 139/71 mm Hg to 90/40 mm Hg eight minutes after the injection. ![]() However, she showed delirious features and complained of an extreme urge to defecate. She also lost consciousness but soon recovered it within a few minutes. Three minutes after the injection, the patient started exhibiting a generalized tonic-clonic type seizure with upward deviation of both eyes and unconscious voiding. The timeline of the patient's clinical course is depicted in Fig 1. ![]() The patient was scheduled for brain MRI and MRA and received 6 mL of gadobutrol (Gadovist®, Bayer Schering, Berlin, Germany). She denied any history of allergic reaction during previous examinations using contrast media. She had also undergone three MR examinations during the past 12 years, but none of them were performed with intravenous administration of gadolinium contrast media–two were non-contrast MRs and the other was MR arthrography. The specific names of low molecular non-ionic iodinated contrast media used for CT examinations in 2005, 2010, 2011 were not documented. Previously, the patient had undergone five CT examinations of the chest and kidneys from 2005 to 2013 using various types of contrast media including iopromide (Neovist®, Daewoong Pharma, Seoul, Korea) in 2013 and iopamidol (Pamiray®, Dongkook Ph-arma, Seoul, Korea) in 2012. Her medication list included the following drugs: atorvastatin, atenolol, aspirin, tibolone, and ibuprofen/arginine. She also had a history of left thyroid lobectomy in 1994 and was on medication for tension-type headache, hypertension, and hypercholesterolemia. This case report was approved by the Institutional Review Board of our institution, and the requirement for obtaining informed consent was waived.Ī 66-year-old woman was diagnosed with lacunar infarction involving the right thalamus in 2003, and she was being followed up at the neurology department of our hospital. Here we report a case of a severe immediate adverse reaction to MR contrast media in order to inform the readers about the diagnosis and proper management of a severe anaphylaxis adverse reaction associated with the use of gadolinium-based MR contrast media. The incidence of severe acute adverse reactions to gadolinium-based MR contrast media is reported to be even lower, in the range of 0.002% to 0.01% ( 1, 2, 3, 4, 5). Previous studies investigated the safety of MR contrast media and reported an incidence of acute adverse reactions in the range of 0.17% to 2.40%, which is much lower than that after the use of low-osmolar nonionic iodinated contrast media for CT ( 3). Despite their relative safety profile, immediate hypersensitivity reactions to gadolinium-based MR contrast media are an area of pressing concern in clinical practice ( 2). Food and Drug Administration three decades ago, MR was thought to be a safer alternative for patients who are allergic to iodinated contrast media for computed tomography (CT) scan ( 1). Since the approval of gadolinium-based magnetic resonance (MR) contrast media by the U.S. ![]()
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