Biomedical subjects
Publications and source records attributed to R C Schmidt.
The non-ionic water-soluble contrast medium Amipaque (metrizamide) shows a lowered neurotoxicity, and therefore it may be used in the entire spinal canal. The better visibility of fine structures compared with oily and gaseous contrast media allows an excellent diagnostic approach to all spinal affections. Our technique of myelography is described and typical examples are given.
Water-soluble contrast media, which have been employed in the examination of the lumbar spinal canal for 30 years, can sometimes result in severe complications, such as arachnoiditis, epileptic seizures, and myoclonic spasm. These complications have been seen less frequently since the advent of metrizamide, a new non-ionic water-soluble contrast medium. However, a further neurological complication has now arisen--mental disorder, varying in kind and degree; for example, organic psychosis and perceptual disturbance. Some characteristic cases are described. A series of 75 patients, all of whom received varying amounts of metrizamide for the purpose of cervical, thoracic and lumbar myelography, has been studied. Seven patients were found to have a pronounced organic psychosis and three patients had visual illusions or hallucinations. It is suggested that there is some degree of correlation between the total amount of iodine received and patient age. By careful enquiry and examination, similar disturbances were also found some 4-8 h after myelography with other water-soluble contrast media.
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A simple method for the combined examination of the cervical spinal canal with Amipaque, and of the craniocervical junction with air, by one and the same puncture without changing the patient's position during the examination, is described.
The myelographic diagnosis of lumbar disc herniations remains unclear in about 5% of the cases. When the clinical examination does not allow clear localisation of the segmental level of the lesion and symptomatology is atypical, discorgraphy may be the only procedure providing further diagnostic information. Very lateral as well as ventral disc herniations can thus be clearly demonstrated. Knowledge of both typical and atypical findings is, however, required to avoid false negative results.
A case of partial aplasia of the right internal carotid artery with an unusual artery passing through the skull base below the hypophysis is described. An association between the presence of this vessel and recurring abnormalities of eye movements with alternating ptosis is assumed. The ontogeny and phylogeny of this collateral artery are discussed.
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Lumbar discography is a good supplement to myelography in the evaluation of low back pain and sciatica. Knowledge of both typical and atypical findings helps to avoid false positive and negative diagnoses. On the other hand atypical findings may show up pathological processes, elsewhere only seen by pathological anatomy. In some cases a relation between these phenomena and clinical symptoms is found.
Anterior lumbar disc herniations can easily and clearly be evidented by discography. The morbidity and, especially, the clinical importance of this entity, however, has been described by some authors only. According to our own experience with discography, ventral lumbar disc herniation seems to be correlated with a painful syndrome consisting of both a typical and circumscribed backache and pain radiating into the abdominal cavity and genital area along the lateral aspect of the lumbar region.
The non-ionic water-soluble contrast medium metrizamide (Amipaque) allows the examination of all regions of the spinal canal. Excellent visualization, the low toxicity for nervous tissue, and small side effects make metrizamide the best contrast medium for myelography, even in infants and children. The technique used is described and results are demonstrated.
Six cases of traumatic aneurysms of the extracranial internal carotid artery are presented. It has been an unexcepted finding in all patients without actual clinical importance. Angiography has been repeated in two cases. Possible sequale of these lesions are discussed.
Metrizamide (Amipaque) has been used as the contrast medium for angiography in neuroradiological investigations. Solutions containing 280 mgI/ml. are well tolerated and produce good contrast. The most important difference from previously used contrast media is the lack of pain when injections are made selectively or super-selectively into the external carotid artery and its branches, or into the spinal arteries.
Xeroradiography, particularly in addition to conventional tomography, for cervical myelography using water-soluble Metrizamide has been tested. Xerography was done in 30 of a total of 96 examinations and could be compared with conventional X rays. In the sagittal plane there was no advantage, in the lateral plane detail was clearer, especially at the cervico-dorsal junction and in establishing the extent of osteochondrotic changes narrowing the subarachnoid space. Xeroradiography should not be used routinely, but has its merits for certain problems, when higher radiation will be justified.
The importance of x-ray-investigations of skull is demonstrated in ten remarkable examples. Mostly intracerebral calcification follows inflammatory, traumatic, neoplastic or metabolic disease. In spite of the simplification of contrast-investigations which have assumed great importance x-ray-films of skull often permit specific diagnostic assessment and therefore should be done first.
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