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PubMed1982

[Total myelography with metrizamide through the lumbar route (author's transl)].

Total myelography with metrizamide at a concentration of 270 mgI/ml was carried out via lumbar puncture in 170 consecutive patients. Good opacification and/or diagnostic value was obtained in the lumbar, thoracic and cervical region at 88.8%, 77.6% and 72.4% respectively. Unsatisfactory results were mostly due to the poor technique of physicians and x-ray technicians. Also it was inadequate to perform this study in some lesions, such as ruptured arterio-venous malformation and occification of posterior longitudinal ligament. Several cases with previous oil myelography showed poor results, because the remaining of Myodil disturbed a good spreading of the newly injected media. It was requested to evacuate oily contrast media prior to metrizamide myelography. One of the most important clues to a successful myleography was to make dilusion of contrast media as little as possible, and the use of high concentration of metrizamide (250-270 mgI/ml) seemed to be tolerated. It was also important to avoid excessive movement of the patient and the rapid transit of the contrast media to the level of interest. It was recommended to study the entire spinal subarachnoid space as a whole. In sixty-three patients out of 170, one or more abnormal myelographical findings were detected at unexpected level. Immediately after the examination the patients were encouraged to drink a large quantity of diuretic beverages such as tee, juice or coffee for the purpose of reducing side effects. As Potts and coworkers and Eldevik and associates reported, it was recognized that the overhydration could reduce the severe side effects after the metrizamide myelography.

Adolescent↗
PubMed1982

[Side effects of metrizamide (Amipaque) cervical myelography (author's transl)].

Thirty-four patients were submitted to the conventional cervical myelography by administration of metrizamide (Amipaque) through three routes (lumbar 23, suboccipital 6, C1-C2 lateral 5). After the injection of metrizamide (4-11 ml, 170-250 mgI/ml), all procedures of the cervical myelography were done as soon as possible within 9 minutes. The adverse reactions of Amipaque were observed in 29 cases (85%) out of 34 cases initially 1 hour after cervical myelography and disappeared completely in an average of 16 hours. The total number of the side effects was 140 incidences such as meningeal irritation (headache 18, nausea 17, vomiting 17), cerebellar signs (dizziness 11, dysarthria 8, tremor 5, bradylalia 2, dysmetria 2, tipsy feeling 2, dysdiadochokinesis 1), autonomic signs (flushing 7, pale face 4, fever 4, sweating 2, hiccup 2, fatigability 2, micturition disturbance 1), sensory signs (exacerbation of numbness 6, perioral numbness 3, back pain 1, chest pain 1), motor signs (focal muscle spasm 5, exacerbation of paresis 4, areflexia 1), psychiatric signs (dysphasia 3, disturbance of consciousness 2, euphoria 1, persecutory delusion 1) and muddiness 7. We observed that waxing and waning of side effects correlated tightly with transient cortical penetration of dye in CT and cortical dysfunction mainly slowing of the background activity and slow wave burst in EEG. According to high frequency of side effects in our study, we suggest that a greater incidence of side effects may result when high concentration of Amipaque comes in contact with the cerebral cortex by using an inadequate fluoroscopic table which has only fixed one plane image and rough positioning control. Slow absorption into blood stream may affect appearance and maintenance of side effects. In order to decrease side effects after Amipaque cervical myelography, we propose that we should introduce a mobile rotating chair coupled with high power image and chose C1-C2 lateral route using 1500-1700mgI of Amipaque.

Adolescent↗
PubMed1980

Bacterial meningitis after myelography.

Two cases opf bacterial meningitis due to streptococci occurred following Pantopaque myelography. These are, to our knowledge, the first reports of Streptococcus mitus and group G streptococcus causing meningitis in this situation. These 2 cases emphasize the importance of considering the possibility of bacterial meningitis following myelography and the difficulty in differentiating it on clinical grounds from the more common aseptic meningitis that occurs after myelography. They also emphasize the importance of maintaining strict sterile technique during myelography.

Adolescent↗
PubMed1995

[Meningitis after myelography].

Lumbar myelography is still frequently used in cases of suspected lumbar radiculopathy. Since 1984, iohexol has been the contrast medium of choice in myelography, and so far only a few cases of chemical meningitis have been reported. Bacterial meningitis cannot be distinguished from chemical meningitis on the basis of clinical findings. A cerebrospinal fluid Gram stain and culture are the only truly reliable tests in deciding the etiology of the meningitis. We describe two patients who developed meningitis following myelography with iohexol. In one of the patients, the cerebrospinal fluid culture was positive with subsequent identification of Flavobacterium meningosepticum, a species not previously reported as an infectious agent in meningitis after myelography.

Adult↗
PubMed1994

Lumbar myelography: side effects correlated with exam findings and needle size.

STUDY DESIGN: The adverse effects of lumbar myelography in 400 patients were analyzed. OBJECTIVES: To determine whether adverse effects of lumbar myelography occur less frequently when using the fine needle technique. SUMMARY OF BACKGROUND DATA: Lumbar myelography can be performed safely on an outpatient basis. The side effects may be reduced by using the fine needle technique. METHODS: Four hundred patients were studied; 200 with a 25 gauge needle and 200 with a 22 gauge needle. Each was given a questionnaire and instructed to report details of post-myelogram adverse effects. RESULTS: Transient worsening of back or leg symptoms, headache, and nausea and vomiting, the most frequent complaints, were reduced in the 200 patients studied with a 25 gauge needle rather than a 22 gauge needle. Regardless of the needle, patients with normal myelograms reported more adverse effects. CONCLUSIONS: A lower frequency of adverse effects can be achieved when fine needle is used for lumbar myelography. More adverse effects are reported by patients with normal myelograms.

Ambulatory Care↗
PubMed1998

[CT myelography for diagnosis of brachial plexus avulsion in small animals].

Avulsion of nerve roots of the brachial plexus can be diagnosed clinically, neurologically, radiographically and by electromyography. But like the myelography these techniques are inprecise for determination of the severity (partial or complete disruption) and the localization of the lesion. In human medicine the combination of computerized tomography with myelography shows high accuracy. Veterinary reports of experience in this field are not yet known. The aim of the present study was to demonstrate nerve root avulsions using myelography and computerized tomography. Three dogs and one cat with traumatic lesions of the brachial plexus were examined. The lesion could be seen in all patients. Thus CT-myelography results in an improved prognostic assessment of brachial plexus paralysis. Moreover, this technique could become one of the most important diagnostic methods for brachial plexus lesions involving nerve root reinsertion--neurotizations in veterinary medicine.

Animals↗
PubMed1990

Medulloblastomas in childhood: postsurgical evaluation with myelography and cerebrospinal fluid cytology.

Thirty-one children with medulloblastoma treated at the Children's Memorial Hospital have been evaluated with both postoperative myelography and cerebrospinal fluid (CSF) cytological studies. Computed tomography of the spine following myelography was used in an attempt to increase sensitivity. Each study was done 30 days after radical resection of the posterior fossa tumor, and just prior to the spinal irradiation. Only 3 (9.6%) showed positive results for spinal subarachnoid seeding by both myelography and CSF cytology. In 2 of these patients, preoperative head CT showed evidence of intracranial subarachnoid seedings. The incidence of positive myelographic finding in our series is lower than reported ones, and neoplastic cells are detected in the CSF only when the myelography shows visible disease.

Adolescent↗
PubMed1999

Evaluation of the role of magnetic resonance myelography in lumbar spine imaging.

The purpose of our study was to evaluate the accuracy of MR myelography in depicting disc herniation in the lumbar spine when compared with conventional MRI in patients presenting with clinical evidence of disc herniation. One hundred patients referred for conventional MR imaging of the lumbar spine also had coronal MR (TR 9000 ms, TE 272 ms eff, NEX 3, echo train length 32) myelography performed. Three experienced observers compared magnetic resonance myelography (MRM) with conventional lumbar spine MR using the following variables: visibility of thecal sac and nerve roots, and the presence, location and severity of disc herniation. Disc protrusions were seen at 110 disc space levels on conventional MR images as opposed to 93 on MRM. However, only 72 % of lesions seen on conventional MR were diagnosed by MRM. Similarly, only 63.8 % of nerve root compression abnormalities seen at conventional MR were visualized when compared with conventional MRM. The sensitivity, specificity and accuracy of MRM when compared with conventional MR was 72, 93 and 85 %, respectively. The MRM technique yields images that resemble conventional myelography and may be used to help confirm abnormalities seen on conventional MR in selected cases; however, the large number of false-positive and false-negative examinations indicates that caution should be used in interpreting MRM images.

Humans↗
PubMed1996

MR myelography of the cervical spine.

In previous studies, magnetic resonance (MR) myelography was not effective in the cervical region. However, effective cervical MR myelography is possible with a modified fast spin-echo sequence (8,000/360 [repetition time msec/effective echo time msec], four signals averaged, echo train length of 24). In a clinical study of this protocol, MR myelography was performed as an additional sequence following conventional MR imaging; composite images were obtained with a maximum-intensity projection algorithm. The MR myelographic sequence added only 8.5 minutes to the total imaging time and yielded information not provided by MR imaging in 13% of patients. MR myelography was especially valuable in demonstrating abnormal intraspinal vascularity and in guiding patient treatment by providing detailed preoperative information about intradural masses and posttraumatic and postoperative diverticulum and meningocele. This MR myelographic technique is a useful adjunct to MR imaging, especially in cases in which the more detailed information provided will be helpful in the analysis of complex intraspinal disease.

Adult↗
PubMed2001

[Side effects after lumbal myelography. A prospective study of outpatients.].

INTRODUCTION: Since myelography was first introduced, hospitalization has been considered necessary. The incidence of side effects and their severity is considerably less since the introduction of water-soluble contrast media, and today the procedure is carried out on outpatients in many X-ray departments. The aim of this study was to examine the incidence of side effects after lumbal myelography performed at the Radiological Department of Reykjavík City Hospital. MATERIAL AND METHODS: Patients referred for lumbal myelography during a five month period from January to May 1995 were included in the study group. All data were prospectively collected. All procedures were carried out in the same way. The injection was most often between the lumbar vertebrae L3/L4. The same quantity of iodine was used in each case. After the examination, patients were permitted to sit in the waiting room and move about freely, but remained under the supervision of the department for three hours. Patients answered three questionnaires regarding their condition before the examination, after, and again two days later, to obtain a general assessment of the total discomfort and also to see whether they had followed directions. RESULTS: Ninety nine patients were included in the study. The total response rate was 89-97%. Most patients were given instructions at the end of the procedure and followed those directions. At the end of the procedure totally 44% of the patients had complaints of headache, 23% of nausea and 44% of pain at the injection site. Before the procedure 93% of the patients had complaints of pain in the back, 86% in the thighs and 77% had complaints of pain in the calves. Immediately after the procedure 54%, 71% and 66% had complaints of pain in the back, thighs or calves. Two days days later 75% had complainst of pain in the back. The large majority of the patients, or 83%, viewed the procedure as having caused little discomfort. CONCLUSIONS: The incidence of side effects from lumbal myelography performed at the X-Ray Department of Reykjavík City Hospital is within acceptable limits.

English Abstract↗
PubMed1985

Prolonged confusion due to absence status following metrizamide myelography.

A case of absence status epilepticus resulted from metrizamide myelography. The acute confusional state following metrizamide myelography is briefly reviewed and compared with the confusional state resulting from adult-onset absence status. The similarities suggest that absence status may in fact be a relatively common cause of prolonged confusion following the use of metrizamide. Given the difficulty in clinical diagnosis and the excellent response to anticonvulsants, the possibility of absence status should be specifically excluded by EEG in any person suffering prolonged confusion following metrizamide myelography.

Aged↗
PubMed1985

Metrizamide myelography in patients with small cell carcinoma of the lung suspected of meningeal carcinomatosis.

Twenty patients suspected of meningeal carcinomatosis (MC) secondary to small cell carcinoma of the lung were evaluated by myelography and by cytologic examination of cerebrospinal fluid (CSF). In 4 patients both investigations demonstrated MC. Four had positive cytology but a negative myelogram. Five patients had a positive myelogram but negative cytology. Thus 13 of the 20 patients had MC diagnosed by one or both of these investigations. Two additional patients suspected of MC were studied; both had positive myelography, but cytologic examination of CSF was not performed in either case. Six patients underwent autopsy with microscopic examination of the spinal cord; in all cases post-mortem findings supported myelographic findings. In conclusion, myelography is useful in the evaluation of patients suspected of MC secondary to small carcinoma of the lung and complements the diagnostic role of CSF examination.

Carcinoma, Small Cell↗
PubMed1981

CT scanning versus myelography in the diagnosis of lumbar stenosis. A preliminary report.

To assess the diagnostic accuracy of CT scanning in lumbar stenosis, twenty-nine patients in whom water-soluble myelography showed degenerative bony encroachment of suggested developmental narrowing of the spinal canal were scanned at all lumbar levels, and CT images were compared with myelographic findings. In developmental stenosis computerised tomography was found to be less accurate than water-soluble myelography, whereas in most cases of degenerative stenosis CT findings correlated well with myelographic patterns. An intermediate accuracy index was found in combined stenosis. In central degenerative encroachment of the spinal canal surgical treatment may be undertaken on the basis of CT findings. In the preoperative evaluation of the other types of lumbar stenosis CT scanning with 8-mm thick slices represents a useful adjunct to myelography, but cannot replace this investigation.

Adult↗
PubMed1988

F-responses after metrizamide and iohexol lumbar myelography.

We measured several F- and averaged F-response variables before and after lumbar myelography with metrizamide and iohexol in order to evaluate possible effects of these contrast agents upon proximal motor nerve conduction and motor neurone exitability. Averaged F-response onset latency increased while both duration and amplitude decreased after iohexol myelography. These changes were interpreted as signs of minor neural depression but they were slight and without clinical significance in the individual patient. F-response variables were not affected after metrizamide myelography.

Electromyography↗
PubMed1989

Which factors affect reported headache incidences after lumbar myelography? A statistical analysis of publications in the literature.

Nineteen publications were reviewed and subjected to a combined statistical analysis (meta-analysis) regarding the influence of study design factors upon reported headache and total symptom incidences after lumbar iohexol myelography. A significant association was found between reported side effects on one hand and needle diameter, follow up time and the method of questioning respectively on the other. The combination of long follow-up time and specific questioning and the combination between larger diameter (20G) needles and long follow-up time, both seemed to be strong predictors for reporting high side effect incidences. Nine studies were similarly analyzed regarding the influence of early ambulation and contrast type upon reported headache incidences. Early ambulation significantly increased headache after iohexol or iopamidol lumbar myelography as opposed to metrizamide myelography.

Early Ambulation↗
PubMed1984

Iohexol compared to metrizamide in cervical and thoracic myelography. A randomized double blind parallel study.

A randomized double blind study with iohexol (Omnipaque) and metrizamide (Amipaque) in cervical myelography was performed in 50 patients, 29 with iohexol and 21 with metrizamide. The myelographies were performed either with lumbar or with C1-C2 puncture in about equal groups, using 300 mg I/ml and 240 mg I/ml of the contrast media respectively. The image quality was equal with both contrast media, excellent in about 4/5 and good in 1/5 of the examinations. Subjective side effects were twice as frequent with metrizamide as with iohexol. The most frequent side effect was headache, occurring in 34% with iohexol and in 67% with metrizamide. Altogether 24% or the patients had EEG changes after iohexol as compared to 47% after metrizamide. All EEG changes were slight dysrythmia-except in three patients with spike activity after metrizamide. These were the only ones with mental reactions as well. It can be concluded that in this trial iohexol was better suited for cervical myelography than metrizamide.

Adult↗
PubMed1977

Cardiovascular reactions to myelography with watersoluble contrast media.

Arterial blood pressure and heart rate were recorded for 5 to 7 h during myelography with iothalamate meglumine and metrizamide in 23 rabbits. After 0.6 ml iothalamate meglumine containing 280 mg I/ml a significant decrease in blood pressure and signs of circulatory failure were found. After identical doses of metrizamide and after reduction of the dose of iothalamate meglumine to 0.4 ml containing 140 mg I/ml no significant fall in blood pressure was recorded. A decrease of blood pressure was always accompanied by a decrease of heart rate. Arterial blood pressure and heart rate during experimental myelography are suggested as useful variables in the evaluation and comparison of new contrast media for myelography.

Anesthesia, Intravenous↗
PubMed1979

Subclinical organic psychosyndromes on intrathecal injection of metrizamide for lumbar myelography.

Eighteen patients with symptoms and signs of possible lumbar disc herniation, who had no evidence of a preexisting organic psychosyndrome were included in the study. An organic psychosyndrome was found in six of them 10 h after lumbar myelography with metrizamide. The psychosyndrome, which was characterized by impaired memory and depression, could be demonstrated only by psychometric methods. In these patients metrizamide could be demonstrated within the basal cisterns by computed tomography 8 h after lumbar injection of the contrast medium. The organic psychosyndrome was completely reversible; five days after myelography it could not be detected any more by psychometric means. The development of an organic psychosyndrome in six of the 18 patients suggests a neurotoxic effect of metrizamide. This assumption is supported by hypo- and areflexia in four patients after intrathecal metrizamide as well as by EEG changes seen in three patients after myelography. There was no correlation between the EEG changes or reflex abnormalities and the organic psychosyndrome.

Adult↗