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PubMed1996

[Magnetic resonance myelography with a fast-spin-echo sequence].

A major application of Magnetic Resonance Imaging (MRI) consists in the "myelographic effect", characterized by high signal intensity of the CSF, which permits to visualize spinal subarachnoid spaces and nerve root sheaths. Such new ultrafast pulse sequences as fast spin echo (FSE) further enhance CSF high signal intensity. In addition, suppressing background with the fat suppression technique and with maximum intensity projection (MIP), a particular algorithm already used in MR angiography, FSE sequences yield 3D myelography-like images. Our study was aimed at assessing the clinical role and the reliability of this technique. Our preliminary experience is based on 21 patients with pain in the lower back and legs and on 5 healthy volunteers; all the myelography-like images were obtained with a 1.5-T MR system (Signa, General Electric). The parameters for FSE myelography-like images included: TR = 6000, TE = 200, ETL = 32, thickness = 3 mm, matrix = 256 x 224, Nex = 4, FOV = 20 cm, fat presaturation, no phase wrap, acquisition time = 2 min 58 s. MR myelography sequences were acquired after a standard FSE T1/T2-weighted exam. MR-myelography results confirmed the diagnosis of disk herniation made on conventional T1/T2-weighted images, especially in thecal sac compression and/or amputation of nerve root sheaths. MR myelography appeared to be especially useful in migrated disk herniation or in abnormal origin of nerve roots. Moreover, it allowed full and panoramic visualization of the subarachnoid spaces and excellent definition of the thecal sac, nerve roots and nerve root sheaths. In one patient only movement artifacts affected image quality. To conclude, even though it fails to yield any functional information, MR myelography appears to be an easy, rapid and noninvasive support to conventional MRI of the lumbar spine, to replace conventional myelography.

Female↗
PubMed2000

[Value of MR myelography in the diagnosis of the spine disorders].

To evaluate the utility of myelography obtained with MR imaging (MR-myelography) as a complementary tool in patients studied with a conventional MR examination of the spine. 275 consecutive patients were included. All of them were studied with MR-myelography in 2 planes, coronal and sagittal, with a turbo spin-echo single-shot technique, as a complement to a conventional MR study of the spine; 130 were males and 145 women, with ages ranging from 20 to 71 years (mean, 45 years). The analyzed variables were age, sex, vertebral segment studied, alteration of the dural sac, intradural nerve roots, emergent roots, and presence of intradural lesions, meningeal cysts, and spinal stenosis. The added value of MR-myelography regarding conventional MR was categorized. MR-myelography obtained new information in 88 cases (32%), being considered irrelevant information in 42 cases and relevant in 46 cases (16.7% of all cases) (amputations of the emergent roots and alterations of the intradural roots). MR-myelography did not contribute to any type of additional information to the conventional MR study in 187 cases (68% of all studies). MR-myelography is a rapid acquisition technique that supplements the conventional MR study of the spine, contributing with relevant new information in the analysis of the spine diseases 16.7% of cases.

Adult↗
PubMed2005

Magnetic resonance myelography evaluation of the lumbar spine end plates and intervertebral disks.

PURPOSE: To evaluate the value of magnetic resonance (MR) myelography in the evaluation of intervertebral disk and end-plate degenerative changes in the lumbar spine. MATERIAL AND METHODS: Conventional MR and MR myelography examinations were performed in 150 consecutive patients (69 F and 81 M, mean age 45+/-15 years, range 18 89). Sagittal T1 and T2-weighted TSE images were compared to MR myelography obtained with a multishot-TSE-T2-weighted sequence (4000/250/fat suppression). Coronal, sagittal, and both oblique MR myelography projections were obtained. Image analysis was carried out independently by two radiologists who categorized lumbar disks into normal, degenerated, or edematous; and vertebral end plates into normal, edematous, or with fatty changes. The proportions were statistically compared at every lumbar intervertebral level. RESULTS: There was good agreement in the classification of disk disease (Kappa: 0.8-0.9). MRI detected a larger number of disk degeneration and end-plate fatty metamorphosis, while the MR myelography technique depicted a larger number of edematous disks and end plates. CONCLUSION: MR myelography was of limited value in detecting the same vertebral end-plate changes observed in MRI, although with similar findings in disk disease. However, the higher detection of edema changes by MR myelography should be analyzed prospectively, as it could be more sensitive than conventional MR sequences.

Adolescent↗
PubMed1990

Intracranial iohexol-distribution following cervical myelography, postmyelographic registration of adverse effects, psychometric assessment and electroencephalographic recording.

Cervical myelography (CM) was taken from 14 cases with cervical root-compression symptoms. Prior to myelography, there was complete cranial CT registration to assess the subarachnoid, intraventricular, subcortical and periventricular densities. Control scans at 3,6,24 and 48 h following myelography disclosed intracranial contrast medium at level of basal cisterns, the fourth ventricle and fissura Sylvii. Nine and 11 patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement, and 9 patients had periventricular enhancement; at the 3-h control CT after myelography a minor subcortical edema was disclosed, which declined during the following hours. Two days after myelography, a minimal residual contrast was disclosed subcortically at the level of fissura Sylvii and in the subarachnoid space at the level of fissura Sylvii and the convexity. Hence, we recommend, that diagnostic cranial CT is performed before or postponed until 3 days after cervical myelography. The patients were questioned about adverse effects, and they underwent psychometric assessment and EEG-recordings: 11 had adverse effects, chiefly mild and exclusively transient, without sequelae. Three patients had no side effect. The psychometric assessment, however, disclosed pronounced deterioration in all patients at test 28 h after myelography, especially marked in the verbal paired associates test, however these disturbances were totally absent at retest one week later. No EEG-abnormalities developed; consistently, no patient had seizures. In conclusion, following CM iohexol is taken up by the brain parenchyma, gradually disappearing within 48 h, during which time a brain CT will be disturbed. During the same period some deterioration of psychometric tests may be found.

Adult↗
PubMedDate not supplied

Comparison of magnetic resonance imaging and myelography in 18 Doberman pinscher dogs with cervical spondylomyelopathy.

Eighteen Doberman pinscher dogs with clinical signs of cervical spondylomyelopathy (wobbler syndrome) underwent cervical myelography and magnetic resonance (MR) imaging. Cervical myelography was performed using iohexol, followed by lateral and ventrodorsal radiographs. Traction myelography was performed using a cervical harness exerting 9 kg of linear traction. MR imaging was performed in sagittal, transverse, and dorsal planes using a 1.5 T magnet with the spine in neutral and traction positions. Three reviewers independently evaluated the myelographic and MR images to determine the most extensive lesion and whether the lesion was static or dynamic. All reviewers agreed with the location of the most extensive lesion on MR images (100%), while the agreement using myelography was 83%. The myelogram and MR imaging findings agreed in the identification of the affected site in 13-16 dogs depending on the reviewer. MR imaging provided additional information on lesion location because it allowed direct examination of the spinal cord diameter and parenchyma. Spinal cord signal changes were seen in 10 dogs. Depending on the reviewer, two to four dogs had their lesions classified as dynamic on myelography but static on MR images. Myelography markedly underscored the severity of the spinal cord compression in two dogs, and failed to identify the cause of the signs in another. The results of this study indicated that, although myelography can identify the location of the lesion in most patients, MR imaging appears to be more accurate in predicting the site, severity, and nature of the spinal cord compression.

Animals↗
PubMed1996

Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma.

OBJECTIVE: Recent advances in neurosurgical treatment of traumatic and birth-related brachial plexus injuries require differentiation of preganglionic nerve rootlet avulsion from postganglionic lesions. The purpose of this study was to evaluate the efficacy of thin-section high-resolution CT myelography for revealing cervicothoracic nerve rootlet avulsion in patients with brachial plexus injuries before surgery. MATERIALS AND METHODS: We evaluated eight patients with posttraumatic or birth-related brachial plexus injury on cervical plain film myelography and high-resolution CT myelography before surgical exploration and repair. CT myelograms were retrospectively evaluated for nerve rootlet avulsion, traumatic pseudomeningocele, and deformity of the subarachnoid space. Results were correlated with surgical exploration and intraoperative somatosensory evoked potentials. RESULTS: Seventy-two (95%) of 76 imaged cervicothoracic levels were adequately shown on CT myelography. Nerve rootlet avulsion, or preganglionic disruption, was shown at 21 levels. Associated pseudomeningocele, or deformity of the subarachnoid space, was seen at 12 (57%) of the 21 avulsion levels. Surgical exploration and intraoperative somatosensory evoked potentials showed complete preganglionic nerve rootlet avulsion at 22 levels. One of the complete avulsions revealed by surgery was not included on the patient's CT myelogram. Of the 21 imaged levels, 20 were correctly revealed on CT myelography (95% sensitivity, 98% specificity). At surgery, partial nerve rootlet avulsion was found at three other levels. None of the partial avulsions was correctly identified on the CT myelograms. CONCLUSIONS: High-resolution CT myelography with thin contiguous axial section is sensitive for revealing complete nerve rootlet avulsion in patients with brachial plexus birth palsies and brachial plexus injuries after trauma. Preoperative CT myelography in these patients allows a more complete injury evaluation for accurate prognosis and surgical planning.

Adolescent↗
PubMed2005

Myelography complications and current practice patterns.

OBJECTIVE: Relatively few data are available in the literature on postmyelography complications. Also, no consensus exists on the need to screen myelography patients for use of potentially epileptogenic drugs, metformin, and aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) or to routinely check prothrombin time (PT) and partial thromboplastin time (PTT). We designed a Web-based survey to obtain information on myelography complications and current practice patterns. MATERIALS AND METHODS: An e-mailing was sent to 2,296 members of the American Society of Neuroradiology (ASNR), requesting their participation in a survey, and 351 responses (15%) were received. The survey included questions on the number of myelography examinations performed and the number of seizures and other complications observed in myelography patients; questions on screening for potentially epileptogenic drugs, metformin, and aspirin or other NSAIDs; and a question on checking PT and PTT. RESULTS: Most responding ASNR members (88%) reported no postmyelography seizures, and 82% observed no other significant complications in the past 5 years. A majority of practitioners (63%) screens patients for potentially epileptogenic drugs, 63% of respondents do not advise patients to discontinue metformin use after myelography, 58% do not advise patients to discontinue aspirin or other NSAIDs, and 73% do not routinely check PT and PTT. CONCLUSION: Myelography is generally safe, with a low risk of seizures, contrast reactions, and other significant complications. The results of this study show that a majority of practitioners screens patients for use of potentially epileptogenic drugs, but a majority does not require patients to discontinue use of metformin and aspirin or other NSAIDs, nor do they routinely check PT and PTT before the procedure. These common practice patterns are considered to be appropriate for the safe and efficient performance of myelography.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging.

Surgical management and prognosis of traction injuries of the brachial plexus depend on the accurate diagnosis of root avulsion from the spinal cord. Myelography, computerized tomography (CT) myelography, and recently magnetic resonance (MR) imaging have become the main radiological methods for preoperative diagnosis of cervical root avulsions. Most of the previous studies on the accuracy of CT myelography and MR imaging studies have correlated the radiological findings with the extraspinal surgical findings at brachial plexus surgery. Surgical experience shows that in many cases extraspinal findings diverge from intradural determinations. Consequently, only correlation with the intradural surgical findings will allow assessment of the factual accuracy of CT myelography and MR imaging studies. In a prospective study, 135 cervical roots (C5-8) were evaluated by CT myelography and/or MR imaging and further explored intradurally via a hemilaminectomy. The accuracy of the preoperative CT myelography-based diagnosis in relation to the intraoperative findings was 85%. On the other hand, MR imaging demonstrated an accuracy of only 52%. The most common reasons for false-positive or false-negative findings were: 1) partial rootlet avulsion; 2) intradural fibrosis; and 3) dural cystic lesions. Computerized tomography myelography scans using 1- to 3-mm axial slices prove to be the most reliable method to evaluate preoperatively the presence of complete or partial root avulsion in traumatic brachial plexus injuries. Because extradural judgment of cervical root avulsion can be unreliable, accurate assessment of intraspinal root avulsion enormously simplifies the decision concerning the choice of donor nerves for transplantation and/or neurotization during brachial plexus surgery.

Adolescent↗
PubMed1990

[Intrathecal distribution of iohexol after cervical myelography].

Cervical myelography was performed in fourteen patients under suspicion of cervical disc herniation. Prior to myelography, complete cranial-CT registration of the density in the subarachnoid space, intraventricularly, subcorticaly and periventriculary was performed. Control scans 3, 6, 24 and 48 hours following myelography disclosed intracranial contrast media at level of basal cistern, the fourth ventricle and Sylvian fissure. Nine and eleven patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement and nine patients had periventricular enhancement. At the first three hours after cervical myelography minor subcortical and periventricular edema was disclosed, which resolved during the subsequent hours. Two days after myelography, minimal residual contrast was disclosed subcortically at the level at the Sylvian fissure and in the subarachnoid space at the level of the Sylvian fissure and the convexity. It is recommended, that diagnostic cranial-CT is performed before cervical myelography or at a minimum of three days after cervical myelography.

Adult↗
PubMedDate not supplied

Conventional and CT metrizamide myelography in Arnold-Chiari I malformation and syringomyelia.

Four normal controls and 26 cases of Arnold-Chiari I malformations and/or syringomyelia were reviewed. The pathologic cases included five isolated Arnold-Chiari I malformations, nine communicating syringomyelia, five idiopathic syringomyelia, four posttraumatic syringomyelia, one syringomyelia with hemangioblastoma, and two postshunt syringomyelia. The objectives of this study were to compare the accuracy of conventional metrizamide myelography with CT metrizamide myelography and to study indirectly the hydrodynamics of CSF flow in syringomyelia by comparing the sequential enhancement patterns of the spinal cords and cord cavities in the different groups of patients. Twenty-five patients underwent conventional metrizamide myelography immediately before CT metrizamide myelography, and one patient underwent CT metrizamide myelography only. Scans were obtained 1-2 hr, 4-8 hr, and 12-24 hr after injection of metrizamide, but not all patients were scanned during all three intervals. CT metrizamide myelography was found to be more sensitive than conventional metrizamide myelography in the diagnosis of both Arnold-Chiari I malformation and syringomyelia. Performing just an immediate and a delayed scan was found to be more cost-effective than doing all three scans. Contrary to previous reports, it was found that delayed (12-24 hr) scans demonstrated more syrinx cavities than intermediate ones. In studying the sequential enhancement patterns of the spinal cords and cord cavities, some interesting trends were observed that tend to support the theories of Aboulker and of Ball and Dayan of transneural passage of CSF into cord cavities in syringomyelia.

Adult↗
PubMedDate not supplied

Spinal cord birth injury: value of computed tomographic myelography.

The value of myelography in the assessment of spinal cord injury in the early neonatal period has not been documented, although this study has been recommended frequently in the literature. Eight neonates are reviewed who presented with the clinical features of spinal cord injury and who had myelography performed. Clinical features included difficult delivery, absent respiration, flaccid paralysis, sensory level, and neurogenic bladder. Myelography revealed that 7 patients had the early changes of swollen cord and 1 patient had the late changes of cord atrophy. None of the neonates had surgical intervention. One neonate died at 3 days of age, while 2 others died after prolonged ventilation. Of the 5 infants who survived, 3 still require ventilation and have spastic quadriparesis, 1 has almost recovered completely and 1 had spontaneous respiration and limb movement but brisk deep tendon reflexes when last examined at 1 month of age. Myelography, which was performed in the early neonatal period in our infants, was abnormal in all patients. Myelography is useful in confirming the diagnosis, outlining the level and extent of the lesion, and excluding extramedullary compression. Myelography may assist in the assessment of prognosis but did not alter management in our patients.

Birth Injuries↗
PubMed1997

[MR myelography in spinal canal stenosis].

PURPOSE: The purpose of this prospective study was to evaluate the clinical value of 3D-MR-myelography (3D-MRM) in comparison to myelography and intra-operative findings. MATERIAL AND METHODS: 25 patients with suspected lumbar spinal canal stenosis were studied via myelography and 3D-MRM (volume-data set, 3D-FISP sequence, TR 73 ms, TE 21 ms, flip angle 7 degrees, sagittal slices) besides the routinely acquired sagittal and axial T1- and T2-weighted images. Diagnoses were made by two radiologists and one neurosurgeon without knowing the clinical history and symptoms, in two separate sessions. Results were compared to intraoperative findings. RESULTS: 3D-MRM has the same diagnostic sensitivity (25/25 = 100%) as conventional X-ray myelography (25/25 = 100%) compared to intraoperative findings, but is not invasive and shows more diagnostic details than myelography. Especially in cases of high-grade spinal canal stenosis there is often a lack of intrathecal contrast medium distally of the stenosis. CONCLUSION: 3D-MRM is as good as conventional myelography in predicting intraoperative findings in patients with lumbar spinal canal stenosis. This new method is non-invasive and can be performed routinely on an outpatient basis.

Adult↗
PubMed2002

Intramedullary injection of contrast into the cervical spinal cord during cervical myelography: a case report.

STUDY DESIGN: A case of iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography is reported. OBJECTIVE: To investigate the occurrence of iatrogenic intramedullary contrast injection during a current C1-C2 cervical myelography. SUMMARY OF BACKGROUND DATA: Intramedullary injection of contrast is a rare but serious complication of C1-C2 cervical myelography that has not been reported since the widespread use of magnetic resonance imaging and the NASCIS III study protocol. METHODS: A 39-year-old woman received an iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography. RESULTS: During the procedure the patient reported right-side face, neck, and arm pain and parethesias. After the procedure, right arm weakness and diffuse hyperreflexia developed. Postmyelography imaging demonstrated intramedullary contrast and cord swelling. High-dose methylprednisolone was administered intravenously and the patient's symptoms improved. The literature and management of this rare complication are reviewed. CONCLUSIONS: Intramedullary cord injection is a rare complication of cervical myelography. The mechanism of spinal cord injury appears to involve a combination of physical compression from the injected liquid and neurotoxicity of the contrast material. Iohexol rather than metrizamide should be used when C1-C2 myelography is indicated in patients who are unable to undergo magnetic resonance imaging, or those whose pathology is inadequately demonstrated magnetic resonance imaging alone. In the event of contrast injection into the spinal cord, administration of high-dose methylprednisolone is recommended.

Adult↗
PubMed1986

Iotrol versus metrizamide in lumbar myelography: a double-blind study.

In a prospective, randomized, double-blind study, 49 patients underwent lumbar myelography using iotrol (24 patients) or metrizamide (25 patients). The diagnostic imaging adequacy of iotrol was comparable with that of metrizamide. After iotrol myelography, adverse reactions were fewer, less severe, and of shorter duration than were those following metrizamide myelography. Thirteen of 24 patients (54%) receiving iotrol reported some adverse reactions compared with 24 of 25 patients (96%) receiving metrizamide. Five moderate and one severe adverse reaction occurred in the group receiving iotrol. Fourteen moderate and eight severe adverse reactions occurred in the group receiving metrizamide. Thirty-eight patients underwent electroencephalography both before and after myelography (19 iotrol and 19 metrizamide). None of the EEGs obtained after iotrol myelography changed from baseline, while seven of the EEGs obtained after metrizamide myelography showed changes from baseline. Iotrol was judged superior to metrizamide as a contrast medium in this patient population.

Contrast Media↗
PubMed1987

Comparison of spinal magnetic resonance imaging and myelography in cancer patients.

Spinal involvement by systemic malignancy is common, and often leads to extradural compression of the spinal cord and/or nerve roots by metastases. Rapid, anatomically accurate diagnosis is essential to the successful management of these patients. We compared spinal magnetic resonance imaging (MRI) with conventional myelography in a series of 31 cancer patients being evaluated for myelopathy (N = 10), or back/radicular pain (N = 21). All patients were evaluated between April 1985 and July 1986, and underwent both studies within ten days of each other (median, two days). MRI was performed on a 0.5 Tesla Technicare unit with a body surface coil, and results compared with standard contrast myelography. All studies were reviewed separately and in a "blinded" fashion. MRI and myelography were comparable in detecting large lesions that produced complete subarachnoid block (five of ten patients with myelopathy, three of twenty-one patients with back/radicular pain). In 19 of 31 patients, smaller but clinically significant extradural lesions were found. In nine of 19 cases, these lesions were demonstrated equally well by both modalities; in nine of 19 cases, these lesions were demonstrated by myelography alone; in one of 19, a lesion was demonstrated by MRI alone. Given our current technology, myelography appeared superior to MRI as a single imaging modality. However, MRI may be an alternative in patients where total myelography is technically impossible or unusually hazardous.

Adolescent↗
PubMed1984

Iopamidol and metrizamide for myelography: prospective double-blind clinical trial.

In a comparative randomized double-blind study, 73 patients underwent myelography using iopamidol (36 patients) or metrizamide (37 patients) as contrast medium. The overall diagnostic adequacy of iopamidol myelography was found to be comparable to that of metrizamide myelography. The incidence of examinations graded as superior (64%) or adequate (36%) with iopamidol was equivalent to that with metrizamide (57% superior, 43% adequate). Adverse reactions after iopamidol myelography were fewer, less severe, and generally of shorter duration than those associated with metrizamide. In the iopamidol group, adverse reactions occurred in nine (25%) patients, all of whom experienced mild or moderate headache, one with nausea, vomiting, and fatigue. In the metrizamide group, adverse reactions occurred in 17 (46%) patients, all of whom experienced mild or moderate headache, six with nausea and vomiting and four with back and leg pain. Of nine individuals who underwent myelography using 300 mg 1/ml metrizamide injected via lateral C1-C2 puncture, three experienced a toxic encephalopathy with confusion, dysphasia, headache, nausea, and vomiting, and a fourth individual suffered severe nausea, vomiting, fever, and irregular pulse. Encephalopathy was not observed in any of the 11 patients in whom myelography was performed via lateral C1-C2 puncture with a similar concentration of iopamidol. No seizures were encountered, and no clinically significant changes in laboratory studies were observed with either contrast medium.

Clinical Trials as Topic↗
PubMed1992

Complications associated with the use of iohexol for myelography of the cervical vertebral column in dogs: 66 cases (1988-1990).

Medical records of 66 dogs that had undergone myelography, using iohexol (240 mg of iodine/ml, 0.3 to 0.5 ml/kg of body weight) during a 2-year period, were reviewed. In 3 dogs, myelography was performed twice during different anesthetic procedures. Neurologic abnormalities were more pronounced the day after myelography in dogs with caudal cervical spondylomyelopathy (P less than 0.01), meningitis (P less than 0.01), or extradural tumors (P less than 0.05). Neither anesthetic regimen nor duration of anesthesia significantly affected the frequency of complications. Seizures occurred after myelography in 6 dogs, and 1 dog had seizures after each of 2 myelographic procedures. The frequency of seizures was significantly greater in male Doberman Pinschers afflicted with caudal cervical spondylomyelopathy. Male dogs (P less than 0.01) and Doberman Pinschers (P less than 0.001) had higher prevalence of seizures. Caudal cervical spondylomyelopathy was associated with higher prevalence of seizures, compared with all other diagnoses (P less than 0.001). Seizures were significantly more prevalent when body weight was greater than or equal to 29 kg (P less than 0.001), when greater than or equal to 2 injections of contrast medium were administered (P less than 0.016), or when 2 injections of contrast medium were given at the cisterna magna (P less than 0.015). The 10% prevalence of seizures after myelography with iohexol in the study reported here is greater than in previous reports, but is lower than that reported after myelography using metrizamide.

Anesthesia, General↗
PubMedDate not supplied

Clinical experience with iopamidol for myelography.

Within 20 months 145 ascending thoracocervical myelographies and 155 lumbar myelographies with the nonionic water-soluble contrast medium iopamidol were performed. The iodine concentration given was 250 mg I/ml or 200 mg I/ml respectively. The total iodine never exceeded 2.5 g (8-10 ml). Image quality was assessed in terms of diagnostic value having experience of more than 1,000 myelographies using metrizamide. Picture quality was similar to metrizamide of equal iodine concentration. In 35 patients electroencephalography (EEG) was recorded before and after myelography with iopamidol 250. No changes that could be referred to the contrast medium were seen. There were no adverse reactions to lumbar myelography other than those following the lumbar puncture. In thoracocervical myelography mild and transient side effects occurred in 41 (28.3%). The most common were headache (41 cases), nausea (12), radicular pain (10), and dizziness (five). General seizures and psychopathologic symptoms were not observed.

Adolescent↗