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PubMedDate not supplied

Transient expressive (nonfluent) dysphasia after metrizamide myelography.

Four (3.4%) of 117 patients undergoing metrizamide myelography experienced transient expressive dysphasia 7-8 hr after myelography and lasting up to 36 hr. All four patients had lumbar myelograms obtained with 15 ml of 190 mg l/ml (2850 mg l). Metrizamide was injected via lumbar puncture with a 20 gauge spinal needle under fluoroscopic control. Neurologic complications after metrizamide have been reported, but so far have appeared to be transient. It is likely that the transient expressive dysphasia experienced by the four patients reported here was a neurotoxic reaction, rather than a seizure phenomenon.

Adult↗
PubMed1985

Evaluation of cerebrospinal fluid rhinorrhea by metrizamide computed tomographic cisternography.

Seven interesting and instructive cases of cerebrospinal fluid rhinorrhea evaluated by metrizamide computed tomographic cisternography are presented. The rhinorrhea was spontaneous in three patients and was related to previous head trauma or surgical procedures in four patients. The anatomical site and the extent of the fistula were demonstrated precisely by directly showing metrizamide passing through the bony defect. A combination of bone dehiscence and metrizamide within the adjacent paranasal sinuses or the nasal cavity is also useful in localization. Distortion of the interhemispheric fissure, sylvian fissure, or basal sulci indicates the probability of brain herniation through the defect.

Adolescent↗
PubMed1985

The penetration of metrizamide into the brain after routine lumbar myelography as shown by cerebral computed tomography and its effect on auditory brainstem transmission time.

Metrizamide is a widely used contrast medium with some well known adverse reactions. In a preliminary study, CT scans and brain stem evoked potentials (BAEP) were done before and 18 hours following lumbar myelography on 12 patients. A statistically significant prolongation of the BAEP was observed. Metrizamide therefore seems to be a potent substance in clinical use as indicated by its effect on BAEP. BAEP should not be done within the first few days after myelography with metrizamide.

Aged↗
PubMed1979

Cat optic nerve imaging with metrizamide.

Metrizamide is a water-soluble, nonionic radiocontrast medium that penetrates better into narrow subarachnoid spaces than do oily contrast media or gas. We performed metrizamide optic nerve thecography on five cats with iatrogenic orbital lesions. Optic thecograms successfully demonstrated displacement of the optic nerve, obstruction of the optic nerve sheath subarachnoid space, and extravasation of the contrast medium from a punctured optic nerve sheath. Metrizamide-induced seizures could be prevented by intramuscular preadministration of diazepam.

Animals↗
PubMed1979

Clinical evaluation of metrizamide as a myelographic agent in the dog.

Metrizamide, a new, water-soluble contrast agent, was clinically evaluated as a myelographic agent in 17 dogs. Nine dogs were given lumbar subarachnoid injections and six were given cisternal injections. Two dogs were given cisternal and lumbar injections; in one dog, both injections were given on the same day. The dosage ranged from 0.3 to 0.57 ml/kg of body weight, using an isotonic solution of metrizamide. Of eight dogs given cisternal injections, two experienced convulsive activity requiring diazepam treatment during the anesthetic recovery period. The lumbar injections did not cause convulsions. Satisfactory radiographic density persisted up to 45 minutes after injection, allowing time for several views to be obtained. In general, metrizamide appeared to be an adequate myelographic agent in the dog.

Anesthesia↗
PubMed1980

Metrizamide: a review with emphasis on drug interactions.

The pharmacology, side effects, and possible drug interactions of metrizamide, a water-solulbe contrast medium for myelography, are reviewed. Metrizamide concentration in the brain reaches maximal levels two to six hour after lumbar injection, depending on dose and patient positioning, and is largely (55-96%) excreted from the body after 24 hours. Its lower neurotoxicity, compared with other water-soluble contrast agents, can be attributed in part to its undissociated, non-ionic nature. Common side effects, which include headache, nausea, and vomiting, occur to the same degree as with other myelographic contrast media. Reported data suggest that convulsions, which have occurred in a very small percentage of patients, are related to the amount of contrast medium reaching the brain which, in turn, is largely a factor of dose and examination technique. Although the risk of seizures is small, it is recommended that drugs that lower the seizure threshold (phenothiazine derivatives, butyrophenones, tricyclic antidepressants, and MAO-inhibitors) should be avoided 48 hours before metrizamide administration (if possible), should not be used to control nausea, and should not be resumed for 24 to 48 hours after the myelographic procedure. The value of premedication (e.g., with diazepam) to prevent seizures has not been established and is not recommended.

Antiemetics↗
PubMedDate not supplied

Assessment of craniocervical junction and atlantoaxial relation using metrizamide-enhanced CT in flexion and extension.

Metrizamide-enhanced computed tomographic (CT) myelography has made it easier to define the relation of the spinal cord to the vertebral canal. A flexion-extension metrizamide-enhanced CT technique has been developed to study the craniocervical junction that refines evaluation of the relation between the spinal cord and the foramen magnum, atlas, and axis. This technique was used to study 15 adults who had had a structurally normal examination of the upper cervical cord and foramen magnum. The average movement of the upper cervical cord was shown to be 1 mm. The advantages of the flexion-extension metrizamide-enhanced CT examination were evident in 10 other patients who had a variety of craniocervical junction pathologies.

Aged↗
PubMed1984

A study of computer-assisted tomography. II. Comparison of metrizamide myelography and computed tomography in the diagnosis of herniated lumbar disc and spinal stenosis.

One hundred twenty-two patients with surgically confirmed pathology consisting of either herniated lumbar disc, spinal stenosis, or both were included in this investigation. For each of these patients, preoperative metrizamide myelography and computerized tomography were performed. Each myelogram and CT scan was read blindly so that the neuroradiologist interpreting the study had no knowledge of the patient's surgical pathology, clinical examination, nor any knowledge of the interpretation of the other preoperative test. A painstaking attempt was made to describe precisely both the exact nature of the preoperative myelogram and CT scan interpretations. The correlations between the preoperative interpretation of each test and the observed surgical findings then were analyzed statistically. Based upon this analysis, myelography was found to be more accurate than computed tomography in the diagnosis of herniated lumbar disc (83% vs. 72%). In the diagnosis of spinal stenosis, myelography was slightly more accurate than computed tomography (93% vs. 89%). Based upon the results of this study, the authors conclude that metrizamide myelography is more accurate than computed tomography in the diagnosis of both herniated lumbar disc and spinal stenosis and remains the diagnostic study of choice for these conditions. Furthermore, metrizamide myelography gives the added advantage of visualizing the thoracolumbar junction and, thus, affords the opportunity to diagnose occult spinal tumors.

False Negative Reactions↗
PubMedDate not supplied

Multiplanar metrizamide-enhanced CT imaging of the foramen magnum.

Definition of masses and malformations at the foramen magnum has been less than optimal with traditional radiographic techniques. The use of intrathecal metrizamide with computed tomographic (CT) scanning improves contrast resolution and facilitates detection of abnormalities that may not be apparent on Pantopaque cisternography, plain films, or conventional axial CT alone. Fifty patients with clinically suspected foramen-magnum lesions were evaluated with this technique. Forty were abnormal with the following findings: 14 cases of the Chiari malformation (five cases had associated syringomyelia), five meningiomas, three neuromas, a chondrosarcoma, a chordoma, and five cervical and three brainstem gliomas. Six cases of syringomyelia, a large posterior-fossa subarachnoid cyst, and an anomaly of the cisterna magna were also diagnosed. Sagittal and coronal images were beneficial in defining tonsillar position, configuration of the fourth ventricle, and the relations of mass lesions to the spinal canal and subarachnoid space. Metrizamide CT cisternography provides superior spatial and contrast resolution of lesions at the foramen magnum not obtainable with other radiographic techniques. Morbidity is minimal because of the low dose of metrizamide used. Multiplanar reformations are particularly helpful in assessing anatomic detail not readily recognized on axial scans alone.

Adolescent↗
PubMed1980

The diagnosis of CSF rhinorrhea by metrizamide CT scanning.

A case of cerebrospinal fluid rhinorrhea is presented in which routine diagnostic evaluation failed to disclose the site of leakage. Computerized tomography (CT) scanning with metrizamide, a nonionic contrast medium, provided not only documentation of the leak but also demonstrated the actual sinus involved. Metrizamide cisternography with CT scanning is a valuable technique in the evaluation of CSF rhinorrhea. It may only be used when an active leak is present. The patient described in this report lost several drops of CSF from the nose per minute in the face-down position. Neurotoxicity may be avoided by routine pre-examination medication with valium or phenobarbital. Mixing of the contrast agent with CSF is diminished by injecting in the subarachnoid space at C1-C2. The methods used in this examination and their indications are described, and the literature concerning metrizamide toxicity and pharmacologic properties reviewed.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1980

Asterixis following metrizamide myelography.

Two patients seen after lumbar myelography with metrizamide demonstrated transient confusion and asterixis. Metabolic etiologies were excluded. To our knowledge, these are the first reported cases of asterixis following myelography with metrizamide.

Brain Diseases↗
PubMed1980

Pediatric metrizamide ventriculography.

Although computerized cranial tomography (CT) is useful for the diagnosis of hydrocephalus and various fluid-containing intracranial cysts. CT cannot always define the functional relationship of the cyst to the normal CSF pathways. In such cases, ventriculography may be necessary to determine proper treatment. Metrizamide, a nonionic water-soluble contrast medium, has been used for myelography and ventriculography in adults and for myelography in children. Eleven children have been ventriculograms using metrizamide with conventional roentgenographic techniques. Diagnostic information was obtained in all but one study. No major complications occurred.

Adult↗
PubMed1980

Unusual effects of metrizamide lumbar myelography. Constellation of aseptic meningitis, arachnoiditis, communicating hydrocephalus, and Guillaine-Barré syndrome.

A clinical constellation of aseptic meningitis, arachnoiditis, communicating hydrocephalus, and a Guillain-Barré syndrome occurred following lumbar myelography with metrizamide. To our knowledge, Guillain-Barré syndrome has not been previously described following myelography with any contrast agent. Meningeal reactions and hydrocephalus have been reported with other agents, but this is the first instance with metrizamide.

Aged↗
PubMed1985

Aphasia following pluridirectional tomography with metrizamide. The effect of patient position.

Eight of 67 patients became transiently aphasic after myelography or cisternography with metrizamide. All eight patients had been placed in the left lateral decubitus position for pluridirectional tomography. Immediate EEGs revealed focal left-sided abnormalities in two patients. In one other patient, a computed tomographic scan showed contrast mainly over the left hemisphere. All of the symptoms resolved within 48 hours. In 34 patients who were placed on the right side, no language disturbance was noted. Aphasia after pluridirectional tomography with metrizamide may be due to local irritation of the perisylvian language centers of the dominant hemisphere. The phenomenon is distinct from syndromes of generalized confusion. The complication may be avoided by placing patients in a right lateral decubitus position for pluridirectional tomography.

Adult↗
PubMed1978

Visualization of small extracanalicular neurilemomas by metrizamide cisternographic enhancement.

Metrizamide (Amipaque) computerized tomography cisternography (CTC) provides a rapid, simple, and accurate radiographic modality of intrathecal enhancement for detecting and morphologically characterizing cerebellopontine (CP) angle masses. The technique is of especial value in masses greater than 1.5 cm that are not detected on intravenously enhanced computerized tomography. Metrizamide CTC was used in six patients with no CP angle mass and in four patients with acoustic neurilemomas.

Cerebellar Neoplasms↗