RESUMEN
A 17-year-old female presented to the emergency room with an arrow sticking out the right aspect of her neck. Her vital signs were stable with systolic blood pressure of 117 mmHg, without either tachycardia, dyspnea, or signs of active bleeding. She was fully conscious with intact sensory and motor function on all extremities. Computed Tomography (CT) showed that the tip of the arrowhead lodged at the transverse foramen of the third cervical vertebra. Digital subtraction angiography revealed that the arrowhead lies posterior to the right vertebral artery, narrowly missing it by about two millimeters. Emergency surgery was arranged in hybrid operating suite. An occlusion balloon catheter was introduced to right vertebral artery but not inflated prior to extracting the arrowhead. After extraction, oozing from the wound was noted. We then inflated the balloon while the neurosurgeon performed hemostasis with gauze compression and electrocoagulation probe. The right vertebral angiography after releasing of the balloon showed focal narrowing of the artery without contrast extravasation. The patient was discharged on the fifth hospital day, and no anticoagulant was prescribed due to lack of neurological deficit. Pre-surgical planning and partnership with the neurosurgeon lead to the optimal outcome for this case.
RESUMEN
Objectives: Hypersensitivity reactions (HSRs) are uncommon but serious adverse events following the administration of iodinated contrast media (ICM) prior to CT imaging. While premedication is almost universally given in high-risk patients, there is a lack of evidence regarding the efficacy of such premedication. This study aims to determine the efficacy of premedication with corticosteroids prior to ICM administration in the prevention of HSRs through meta-analysis. Materials and Methods: An extensive review of the literature yielded 404 potentially relevant studies. Of these, five studies met the inclusion criteria of this meta-analysis. Pooled HSR event rates were obtained from each of the studies for both patients who had and who had not received premedication with corticosteroids. Heterogeneity between studies was also determined. Results: A total of 736 patients across all five studies were included in the analysis. Patients who did not receive premedication had initial pooled HSR rates of 0.16 (95% CI, 0.07−0.35) across all studies. Following premedication, pooled HSR rates dropped to 0.02 (95% CI, 0.01−0.06). Patients who had prior HSRs were significantly less likely to experience HSRs (OR = 0.09; 95% CI, 0.03−0.25; p < 0.00001) after treatment with premedication. Conclusions: This meta-analysis offers evidence for the reduction in the recurrence of moderate and severe HSRs in patients who have a history of such reactions. Premedication with corticosteroids prior to ICM administration is thus highly recommended in high-risk patients.