Morphine overinfusion of intrathecal drug administration system under magnetic resonance evaluation for the diagnosis of stroke: a case report

Background Until recently, it is generally considered safe to perform magnetic resonance imaging (MRI) in patients with an intrathecal drug administration system (ITDAS) device. In this study, we presented a case of morphine overdose due to ITDAS malfunction during MRI evaluation for the diagnosis of stroke. Case presentation A 58-year-old woman was referred to the emergency department for left-sided hemiparesis and dysarthria. She had undergone ITDAS implantation 4 years ago because of intractable back pain. Her brain MRI examination did not show any abnormalities except an old hemorrhagic infarction in the right basal ganglia. After MRI was performed, her symptoms completely resolved. Approximately 3 h after the MRI scan, the patient showed progressive stuporous consciousness and decreased respiration with decreased peripheral oxygen saturation of 80%. Initial arterial blood gas analysis revealed respiratory acidosis with hypoxia and hypercapnia. We suspected the opioid overdose for her unconciousness, small and sluggish pupils, and slow respiration. The patient regained consciousness within 3 min after the administration of naloxone with severe anxiety and irritability, without any respiratory symptoms or focal neurological deficits. In the pump interrogation and actual reservoir checks performed 6 h after the MRI scan, there was no significant difference between the expected reservoir volume and actual reservoir volume. Follow-up MRI performed to rule out posterior circulation infarction showed no structural lesions. The patient was eventually discharged without further neurologic or functional deterioration, with diagnosis of transient ischemia attack for initial symptoms of focal neurologic deficits. Conclusion Although both ex vivo and in vivo studies have provided evidence that ITDAS devices are MRI-compatible, the pump is made of titanium and has ferromagnetic components. Since misdiagnosis of overinfusion could lead to mortality, early awareness of overinfusion of the intrathecal drug is needed to all clinicians in case of performing MRI in ITDAS implanted patients.

Awareness about Intrathecal Drug Administration among Dental students

Intrathecal administration includes the immediate infusion of the medication in Cerebro Spinal Fluid(CSF) internal to the intrathecal space of the spinal column. The intrathecal course permits direct medication organization to the CSF by evading the blood-cerebrum hindrance. It permits conveyance of small medication dosages, and the event of adverse effects are decreased compared with systemic courses of medication administration. This survey was performed for assessing the awareness about intrathecal drug administration among dental students. A cross-sectional study was done with a self-administered questionnaire with ten questions circulated among 100 dental students. The questionnaire assessed the awareness about intrathecal drug delivery in medical applications, their medicinal uses, drugs administered, mechanism of action and side effects. The responses were recorded and analysed.17% of the respondents were aware of medical uses of intrathecal drug delivery, 13% were aware of the drugs used in intrathecal drug delivery .10 % were aware of the mechanism of action of intrathecal drug delivery .7% were aware of side effects of intrathecal drug delivery. The awareness about intrathecal drug administration among dental students is not adequate. Increased awareness programs and continuing dental education programs in intrathecal drug delivery should be initiated to improve the awareness levels.