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Neurological Rehabilitation

Gadolinium Neuropathy following MRI: A case report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 5

    Primary Author(s)

  • Matthew Mackey, MD

    Resident Physician PM&R
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greeenville, North Carolina

    • Co-Author(s)

  • AS

    Anne Serrao, DO

    Resident Physician
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

  • DM

    Daniel Moore, MD (Male (XY))

    MD East Carolina University
    ECU
    Greenville, North Carolina

Disclosure(s):
Matthew Mackey, MD: No financial relationships to disclose
Daniel Moore, MD: No relevant disclosure to display
Case Diagnosis: Gadolinium Neuropathy following MRI with Contrast

Case Description or Program Description: 39M w/PMHx of Achillies tendon injury but without DM, spine surgery, or ethanol use experienced R. neck pain s/p fall, undergoing MRI/MRA Nov 2023. Paresthesia immediately began with light touch in BUE and BLE as well as cramps in his hands/forearms and lower legs/feet. Symptoms lessened before presenting to our clinic in May 2024 but were exacerbated by increased physical activity, caffeine, and ethanol. He stated he had ‘toxicity’ from gadolinium following MRI and was treated with fourteen rounds of Ethylenediaminetetraacetic acid (EDTA – a chelating agent used for heavy metal toxicity) and B vitamins. Initial urine gadolinium was elevated at 1.76mcg one month post MRI with a recent level of zero by twelve-hour urine analysis. He was aware that excess B vitamins can cause paresthesia and expressed concern about his elevated B vitamin levels.

Setting: Physical Medicine and Rehabilitation Outpatient Clinic

Assessment/Results: PE without muscle atrophy, 5/5 strength bilateral upper and lower extremities, decreased sensation to light touch at bilateral ankles and feet, and 2+ reflexes except for 1+ DTR at L ankle in setting of old tendon injury.
NCS: normal F waves and no evidence of sensory or motor neuropathy. EMG WNL for several distal bilateral foot muscles. Abnormal R. first dorsal interosseous muscle: non-diagnostic limited finding. Gadolinium toxicity strongly suspected as etiology based on history, labs, and negative EDX findings. We recommended skin biopsy and small sensory fiber testing.

Discussion (relevance): Gadolinium toxicity resulting in neuropathy is an infrequently discussed potential adverse effect from contrast MRI. Evidence of gadolinium neuropathy does not present on standard NCS or EMG as it affects small fibers. Further diagnostic testing may include skin biopsy, QSART, and/or small fiber studies.

Conclusions: Evaluation of neuropathy post MRI with NCS and EMG is useful in narrowing DDx and to tailor further testing.