Gadoxetate Disodium-Enhanced Imaging of Gradenigo Syndrome in End-Stage Renal Disease

Victoria Sattarova, Mehmet Gencturk, Michael S. Lee, Collin M. McClelland

Research output: Contribution to journalArticlepeer-review


ABSTRACT: A 65-year-old man with end-stage renal disease on peritoneal dialysis was admitted for new onset binocular double vision, failure to thrive, and debilitating right-sided headaches. Medical history was significant for tympanomastoidectomy for polymicrobial mastoiditis and treatment with IV antibiotics. MRI brain without contrast was read by radiology initially as showing expected postsurgical changes; however, given patient's history of mastoiditis infection, there was a high clinical suspicion for Gradenigo syndrome. MRI brain was repeated with gadoxetate contrast to minimize the risk of nephrogenic systemic fibrosis (NSF) in a patient with severe renal disease and this revealed an intracranial empyema involving both the trigeminal and abducens nerves confirming the diagnosis of Gradenigo syndrome. This case presented a diagnostic challenge because of suboptimal visualization on initial nonenhanced MRI. Gadoxetate was chosen because of its unique properties including high hepatobiliary excretion making it a safer form of gadolinium-based contrast agent that may not have the potential to precipitate NSF.

Original languageEnglish (US)
Pages (from-to)e375-e377
JournalJournal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
Issue number3
StatePublished - Sep 1 2021

Bibliographical note

Publisher Copyright:
Copyright © 2021 by North American Neuro-Ophthalmology Society.

PubMed: MeSH publication types

  • Journal Article


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