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PubMedDate not supplied

[Gas radionuclide myelography in assessing patency of the subarachnoid space of the spinal cord].

CSF dynamic tests and gas radionuclide myelography were conducted in 184 patients with arachnoiditis, arachnomyelitis, and tumors of the spinal cord and spine. From the findings of myelography, differentiated degrees of retention of the gas radiopharmaceutical (RP) in obstruction of the CSF channels of the spinal cord were distinguished. The relationship between the distinguished degrees of retention of the gas RP and the degrees of CSF dynamics disorder was determined and each method was correlated with the exact diagnosis of the diseases. It was found that to gain a fuller idea of the patency of the CSF channels, the findings of gas radionuclide myelography must be compared with the results of tests for CSF dynamics.

Adolescent↗
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

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↗
PubMed1983

Complications of metrizamide myelography.

Adverse neurobehavioral reactions have not been emphasized as a complication of metrizamide myelography. We encountered six such reactions in approximately 250 metrizamide myelograms. All reactions followed either cervical myelography or panmyelography via lumbar puncture. We also treated a single case of tonic-clonic seizure after intracranial spill of metrizamide in a patient without a history of seizure disorder, and a case of myoclonus following a thoracic metrizamide myelogram that showed a highgrade block. Metrizamide should not be used if an intrathecal block is suspected, or if the location to be studied makes intracranial spill difficult to avoid.

Adult↗
PubMed1984

Cortical blindness after metrizamide myelography. Report of a case and proposed pathophysiologic mechanism.

Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelography. We saw a patient with cortical blindness, seizure, organic psychosis, and asterixis after undergoing attempted metrizamide myelography via C1-2 puncture. Computed tomography demonstrated early penetrance of metrizamide into the brain parenchyma, most prominently in the occipital lobes. A mechanism of direct metrizamide neurotoxicity was proposed.

Adult↗
PubMed1985

Myelography for staging medulloblastoma.

Thirty-eight patients with newly diagnosed medulloblastoma were studied with myelography and cerebrospinal fluid (CSF) cytology studies before radiotherapy. Seventeen (45%) patients had evidence of dissemination beyond the posterior fossa. Spinal cord lesions were demonstrated in ten patients (26%). Negative results of CSF cytology studies did not preclude demonstration of cord involvement. Children younger than 5 years were more likely than older patients to have spinal cord involvement at diagnosis. Patients who were truly M-0 did better in terms of absolute survival but not relapse-free survival when compared with patients with dissemination. Myelography and cytology studies are necessary in the evaluation of all newly diagnosed patients with medulloblastoma and may also be indicated for patients with other brain tumors with a known propensity for dissemination.

Cerebellar Neoplasms↗
PubMed1981

Asterixis and encephalopathy following metrizamide myelography: investigations into possible mechanisms and review of the literature.

Marked asterixis occurred in two patients following metrizamide myelography. One also suffered generalized seizures and the other had severe stuttering speech for seven days. The spectrum of toxic manifestations of metrizamide is reviewed with emphasis on the unusual lethargy and other depressive effects seen with this relatively safe agent. The hypothesis that metrizamide exerts a ouabain-like effect on the cortical surface was tested. Metrizamide in concentrations as high as 20 mM had no inhibitory effect on rat cerebral K+-para-nitrophenylphosphatase, a partial reaction of (Na+K+)-adenosine triphosphatase. Because metrizamide is a 2-deoxyglucose analogue, a competitive inhibition of hexokinase at the first step in glycolysis was also postulated. Metrizamide was found to competitively inhibit commercial (microbial) hexokinase. The Michaelis constant for glucose rises from 0.13 to 0.25 to 0.33 to 0.91 mM in the presence of 0, 0.4, 1.0, and 2.0 mM metrizamide, respectively. Since the concentration of metrizamide over the cerebral cortex after routine myelography may be approximately 50 mM compared with a glucose concentration of only 3.6 mM (65 mg/dl), it is postulated that impaired brain glucose metabolism may be responsible for some of the toxic effects of metrizamide.

Animals↗
PubMed1984

Nonconvulsive status epilepticus following metrizamide myelography.

Epileptic seizures are a known complication of metrizamide myelography. To our knowledge, this is the first report of a case of nonconvulsive status epilepticus of the absence type following metrizamide myelography. There was symptomatic and electroencephalographic improvement after intravenous administration of antiepileptic drugs, and there was no neurological residual. Nonconvulsive status epilepticus should be considered when impairment of consciousness supervenes after radiographic procedures using metrizamide.

Electroencephalography↗
PubMed1988

Seizures following myelography with iopamidol.

Iopamidol, a water-soluble contrast medium, has been rarely associated with seizures. We describe 3 patients (from a series of 785) who had generalized tonic-clonic seizures after iopamidol myelography. Two of the patients underwent lumbar and one cervical myelography. There was a history of seizures in 2 patients, and the dose of iopamidol used in the patients who convulsed was high, ranging from 3,000 to 4,500 mg iodine. Despite the reported low incidence of complications with iopamidol, seizures may occur, especially in patients with previous seizures and also in those receiving higher doses of iopamidol.

Female↗
PubMed1996

Use of a 22-gauge Whitacre needle to reduce the incidence of side effects after lumbar myelography: a prospective randomised study comparing Whitacre and Quincke spinal needles.

In a prospective study lumbar iohexol myelography was performed in 107 consecutive patients, randomised for lumbar puncture with a Quincke or Whitacre spinal needle. All patients answered a questionnaire about possible side effects. Data from 100 patients (58 men, 42 women) were evaluated. In the Quincke group (n = 53), 23 (43%) reported no side effects. In the 30 patients who reported various side effects, post-dural puncture headache (PDPH) occurred in 22 (42%), of whom 9 had mild, 6 moderate and 7 (13%) severe cephalalgia, 18 (34%) reported increased low back pain/sciatica, 5 nausea and 7 dizziness. In the Whitacre group (n = 47), 33 (70%) had no side effects. PDPH was reported by 9 patients (19%), of whom 2 had mild, 6 moderate and only 1 (2%) severe cephalalgia, 4 (9%) reported increased low back pain/sciatica, 5 nausea and 4 dizziness. The conclusion drawn from this study is that lumbar myelography performed with the Whitacre spinal needle reduces postspinal side effects.

Adult↗
PubMed1978

Abducens palsy after lumbar myelography with watersoluble contrast media.

Five patients who developed abducens palsy after myelography with watersoluble contrast media are reported. These palsies can be compared to abducens palsies after spinal anesthesia and diagnostic lumbar puncture. They are most likely due to the lumbar puncture. The arguments for this explanation are discussed. The experience with these five patients suggests a greater incidence of postpuncture abducens palsy after myelography with watersoluble contrast media than after spinal anesthesia or lumbar puncture. If this first impression is verified, it could point to an additional toxic action.

Abducens Nerve↗
PubMed1984

Exacerbation of systemic lupus erythematosus, aseptic meningitis and acute mental symptoms, following metrizamide lumbar myelography.

A clinical constellation of exacerbation of systemic lupus erythematosus (SLE), together with aseptic meningitis, and acute mental symptoms occurred following lumbar myelography with metrizamide. Exacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new.

Delirium↗
PubMed1982

Iopamidol vs metrizamide: a double blind study for cervical myelography.

A double-blind study was performed on 20 patients comparing the safety and efficacy of Iopamidol and Metrizamide in cervical myelography. The radiographic qualities of the Iopamidol and Metrizamide examinations were equivalent when using the same volume (12 to 13 ml), concentration (200 mg I/ml), and a C1-2 route of administration. The performance of a CT scan on selected patients in specified areas of interest provided additional diagnostic information in some patients (e.g syringomyelia, degenerative spondylosis). The adverse reactions were mild in the Iopamidol group with 4 of the 10 patients experiencing no adverse reactions. The more severe reactions, including disorientation, agitation, dysarthria, asterixis, hyperreflexia and EEG abnormalities were limited to the Metrizamide group with one or more occurring in 2 of the 10 patients studied. Only one Metrizamide patient experienced no adverse reactions. In this study containing a limited number of patients, Iopamidol was shown to be a diagnostically effective and safer contrast medium for performing cervical myelography.

Chemical Phenomena↗
PubMed1990

Side effects after lumbar iohexol myelography. Relation to radiological diagnosis, sex and age.

Side effects of iohexol lumbar myelography have been analyzed with respect to the influence of the type of radiological abnormality, sex and age in a group of 200 patients. Headache, postural headache, nausea and back/leg pain were significantly more frequent in patients without definite radiological abnormalities. Postural headache, nausea, dizziness and mental symptoms were more frequent in women, while headache, postural headache, nausea, dizziness, minor mental symptoms (i.e. anxiety or depression) and pain became less frequent with age. This pattern is similar to that reported after lumbar puncture. Young women without definite clinical signs of nerve root lesions probably have the greatest risk of experiencing side effects after iohexol lumbar myelography.

Adult↗
PubMed1980

Mental disorders after myelography with metrizamide and other water-soluble contrast media.

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.

Adult↗
PubMed1985

Computed tomographic myelography (CTM) in atlanto-axial rheumatoid arthritis.

Thirty-two patients with severe cervical rheumatoid arthritis were investigated preoperatively with cervical myelography (CeM) and computed tomographic myelography (CTM). The severity of their clinical symptoms correlated excellently with a combination of the deformation of the spinal cord at the atlanto-axial level, the lateral dislocation of the cord at the same level, and the deformation of the cord at some lower cervical level. Obstructing soft-tissue excrescences seemed to have little significance. No correlation was found in this study between the deformation of the cord and the main findings of the plain films: the atlanto-axial subluxation (AAS), the vertical subluxation (VS), or their combination.

Adult↗
PubMed1985

Routine bed rest is unnecessary after cervical myelography.

After undergoing myelography with iopamidol by either direct puncture (n = 120) or lumbar puncture and run up of the contrast medium (n = 232), the patients were randomly allocated into one of two groups, one group being confined to bed for 24h and the other allowed to be fully ambulant. Questionnaires recording the occurrence and severity of side effects were completed at specific intervals after the myelogram. Adverse reactions experienced were significantly fewer than in our previous direct puncture study using metrizamide. Neither in the direct puncture nor in the run up group were side effects adversely affected by allowing the patients to remain ambulant after the examination. There is, therefore, no necessity to confine patients to bed following cervical myelography.

Bed Rest↗
PubMed1985

Functional cervical myelography with iohexol.

Thirty patients underwent functional cervical myelography, i.e. radiographs in the lateral view were obtained in extension as well as in flexion of the neck. Sagittal tomography was performed in both positions. Widening of the subarachnoid space and decreased sagittal diameter of the spinal cord due to shortening were demonstrated in the lateral view in flexion. In some cases with advanced narrowing or spinal block in extension, such widening in flexion resulted in better diagnostic images by providing passage of the contrast medium caudally. Although iohexol (Omnipaque, Nyegaard & Co., Oslo) was regularly forced into the posterior cranial fossa by the movements, the frequency of side effects was approximately the same as in our former trials with iohexol in conventional cervical myelography. EEG changes occurred in two patients (7%). A sitting position for 3-4 min after the examination followed by an elevated head end of the bed was probably important for preventing side effects from the contrast medium. Specific questioning revealed twice as many subjective side effects as reported after general questions alone.

Adult↗