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PubMed1985

Aphasia, apraxia and neurogenic stuttering as complications of metrizamide myelography (speech deficits following myelography).

Aphasia following metrizamide myelography has been reported infrequently. During a seven-month period, we examined two patients who developed Broca's aphasia, apraxia of speech, oral-buccal-facial apraxia and neurogenic stuttering after intrathecal metrizamide administration. In each case, focal neurologic deficits were accompanied by clinical, electroencephalographic and radiologic signs of generalized neurologic disease. Serial speech and language evaluations initially revealed severe deficits that were largely resolved by the third day post-myelography. Out-patient follow-up examinations demonstrated persistence of mild speech and language abnormalities in each case. Our findings suggest that metrizamide may cause longlasting neurologic dysfunction.

Aphasia↗

PubMed1987

Comparative study of eosinophil purification on Nycodenz, Metrizamide and Percoll density gradients.

Studies on the metabolism of human eosinophils and their interaction with helminthic parasites have been hampered by the difficulty in obtaining these granulocytes in sufficient purity and quantity. In this report, we describe for the first time the application of the density medium Nycodenz for the purification of eosinophils from peripheral blood. Nycodenz density gradient centrifugation is compared with Percoll and metrizamide gradient centrifugation with special emphasis on cell yield, purity of cell suspensions, and functional integrity of separated cells. Percoll gradients provide purer preparations (mean value 94 +/- 15%) of eosinophils from blood with moderate eosinophilia than Nycodenz or Metrizamide (58 +/- 29 and 88 +/- 13%, respectively). The recovery rates of eosinophil-enriched fractions were low after Nycodenz centrifugation (29 +/- 19%) in comparison to Metrizamide (60 +/- 21%) or Percoll (70 +/- 16%). Eosinophils (as neutrophils), prepared by the 3 techniques, function metabolically (superoxide anion generation) and in assays measuring phagocytosis (S. aureus, zymosan particles). Percoll gradient isolated eosinophils (as neutrophils) adhere to and immobilize larvae of Onchocerca volvulus.

Cell Separation↗

PubMed1978

Peridurography with metrizamide: animal and human studies.

Metrizamide (300 mg l/ml) was tested for spinal peridurography in conscious dogs and humans. Epidural metrizamide was non-irritating in volumes up to 12 ml. Larger volumes caused mild discomfort in two patients. Radiographic contrast was satisfactory, and there were no sequelae. Peridurography with metrizamide (300 mg l/ml) appears to be a safe, useful diagnostic procedure in ambulant patients.

Adult↗

PubMed1981

Incidence of adverse effects following metrizamide myelography in nonambulatory and ambulatory patients.

A study was done to determine whether cerebrospinal fluid loss through a lumbar puncture tear or metrizamide contact with central nervous system tissue is the more important contributor to postmyelographic headache. To do this, the influence of postmyelographic positioning was recorded in 43 ambulatory and 43 nonambulatory (confined to bed for 24 hours after the procedure) patients. The incidence of headache was 10.5% in the ambulatory group and 43.6% in the nonambulatory group (p less than 0.01). There were no significant differences between the two groups with respect to leg and back pain or nausea and vomiting. It is concluded that irritation of the central nervous system by metrizamide is more important as a causative factor of postmyelographic headache than is cerebrospinal fluid leakage. Following metrizamide myelography, patients can be encouraged to be ambulatory without any increase in the incidence of adverse effects.

Adult↗

PubMed1983

The value of computed tomographic metrizamide myelography in the neuroradiological evaluation of the spine.

The diagnostic value of plain film metrizamide myelography (PFMM) was compared with computed tomographic metrizamide myelography (CTMM) in a study of 106 individuals who had undergone high-resolution computed tomographic scanning of the spine. CTMM provided more significant information than PFMM in 42 of 106 cases (40%), but showed no advantage over PFMM in 63 of 106 cases (59%). In 19 of the 42 cases (45%), PFMM was useful in directing the CT analysis to the appropriate region of pathology. In one patient, PFMM revealed a mobile herniated disc that had not been visualized with CTMM. In 30 of 106 cases in which plain CT scans of the spine were also obtained, the addition of intrathecal metrizamide demonstrated additional pathology in ten individuals. In general, CTMM was useful in the delineation of a variety of pathologic entities, especially neoplasms and congenital abnormalities. Low-dose CTMM (3 ml of a 150 ml/mg concentration) was performed as an outpatient procedure and found to be a useful adjunct to plain CT in two patients. A schema for the radiological evaluation of pathology of the spine is presented.

Adolescent↗

PubMed1984

Comparison of iohexol with metrizamide in myelography.

Myelography of the lumbar and lower thoracic spine was performed in 46 patients (23 using metrizamide and 23 using iohexol) as a parallel double blind randomized study. Neurological examinations, laboratory testing, and EEG studies were performed before and after myelography, and side effects were recorded. On comparison, adverse reactions were observed in a statistically significant lower number of patients when iohexol was used. The frequency and duration of each single adverse reaction was also lower following use of iohexol, but this was not statistically significant. Three patients had severe reactions following use of metrizamide, and in one patient sharp waves were recorded on EEG. No severe reactions, no mental reactions, and no muscular symptoms were seen following use of iohexol, and we considered this contrast medium better tolerated in the subarachnoid space than metrizamide.

Adult↗

PubMed1984

Epidural block: myelographic evaluation with a single-puncture technique using metrizamide.

A simplified technique using metrizamide for myelographic delineation of extrinsic spinal cord blocks is described. This method was successfully used in eight consecutive examinations without adverse effects. A single lumbar puncture is followed by instillation of metrizamide into the subarachnoid space. With the needle left in place and the patient in the Trendelenburg position, the contrast agent is sequentially displaced above any encountered extradural blocks by further injection of diluent or sterile saline into the caudal thecal sac. Thus, multiple levels of blockage may be defined at their upper and lower margins. This method offers an expedient and safe alternative to combined lumbar and C1-2 lateral cervical puncture, leaves a minimum amount of metrizamide "trapped" below a block, and has several advantages over use of iophendylate. Additionally, the examination may be supplemented with CT scanning when desirable.

Adult↗

PubMed1986

Outpatient metrizamide myelography: prospective evaluation of safety and cost effectiveness.

A group of 228 consecutive patients undergoing metrizamide myelography was prospectively evaluated for postprocedure symptoms. The observed prevalence of these symptoms concurs with previously reported inpatient studies, with the most common sequelae being exacerbation or onset of spine or extremity pain, headache, nausea, and paresthesia. Limitation of administered dose of metrizamide in lumbar myelography may slightly reduce the occurrence of common symptoms, but withdrawal of contrast medium at the completion of examination had no impact on their occurrence. There was a higher occurrence of paresthesia in cervical myelography, but otherwise there was no significant difference in symptoms between cervical and lumbar studies. Outpatient metrizamide myelography can be performed with relative safety with the potential for significant cost savings.

Adolescent↗

PubMed1978

Effect of metrizamide on whole blood oxygen affinity.

The effects on whole blood oxygen affinity following addition to human blood of either ionic (diatrizoate) or non-ionic (metrizamide) contrast medium were investigated in vitro. No medium changed whole blood oxygen affinity. Solutions of metrizamide produced less changes in plasma pH than solutions of diatrizoate. This difference is explained by lower buffer capacity and lower osmolality of metrizamide solutions. Low osmolality gives less redistribution of anions between plasma and red cells and therefore less decrease in plasma pH.

Diatrizoate↗

PubMed1980

Epidurography with metrizamide in Rhesus monkeys.

Epidurography with metrizamide was performed on 9 Rhesus monkeys; physiologic saline was substituted for metrizamide in 3 control monkeys. Metrizamide successfully outlined the epidural space without causing any adverse clinical effects or direct tissue injury.

Animals↗

PubMed1982

Effect of levomepromazine on EEG and on clinical side effects after lumbar myelography with metrizamide.

In patients with lumbago-sciatica levomepromazine is a potent supplement to analgetics in pain treatment. The hypothesis that neuroleptics increase the risk of epileptic seizures after metrizamide myelography was not confirmed in a series of 77 patients, 26 with and 51 without levomepromazine medication, before and after lumbar metrizamide myelography. No differences existed between the groups with regard to the appearance of EEG abnormalities such as slow waves or spikes. Mild side effects were more frequent in the levomepromazine group, except nausea and vomiting. Lumbar metrizamide epidurography in 30 patients did not cause any abnormal EEG.

Drug Interactions↗

PubMed1982

Pain and hemodynamic effects in aortofemoral angiography. Clinical comparison of iohexol, ioxaglate and metrizamide.

Two new contrast media, iohexol (non-ionic monomer) and ioxaglate (monoacidic dimer), were compared with the non-ionic metrizamide during aortofemoral angiography in a single blind randomized trial in 2 groups of patients with 20 in each. The degree of heat and pain produced by iohexol and ioxaglate did not differ significantly from that produced by metrizamide, while subsequent injections of metrizoate caused significantly more heat and pain. The hemodynamic effects recorded in 10 patients in each group showed that iohexol and ioxaglate induced a decrease in vascular resistance, decrease in blood pressure and increase in heart rate not differing significantly from that induced by metrizamide.

Aged↗

PubMed1982

Binding of a metrizamide to human serum proteins.

In connection with the introduction of the non-ionic radiographic contrast medium metrizamide (Amipaque) Salvesen & Frey reported that no significant albumin binding of metrizamide could be revealed by the use of equilibrium dialysis. The protein binding of metrizamide has now been investigated using whole human serum with the aid of an aqueous two-phase system and gel electrophoresis. No binding to serum proteins, at least not to others than albumin could be demonstrated. The possible existence of a minor (less than 1%) protein binding is discussed.

Blood Proteins↗

PubMed1982

Adverse reactions to myelography with metrizamide in infants, children and adolescents. II. Local injury caused by lumbar puncture and injection of contrast medium.

A series of 605 myelographies with metrizamide was reviewed to assess the risk of local injury caused by the puncture and injection of metrizamide. A lesion below the normal level of the medullary conus was found in 139 patients, and in 10 of these the needle went into or through the lesion. One patient developed paraplegia due to the puncture and injection, no other patient had any symptoms. It is concluded that in spite of the risk, lumbar puncture should be the routine procedure for myelography with metrizamide in children.

Adolescent↗

PubMedDate not supplied

Comparison between EEG and observation of rabbit behaviour in evaluation of subarachnoid neurotoxicity of metrizamide.

The non-ionic contrast medium metrizamide (370 mg I/ml) was injected into the cisterna magna of rabbits at 2 dose levels (0.1 ml/kg and 0.5 ml/kg) to investigate whether visually evaluated EEG can detect neurotoxicity at a lower dose level than a method based on observation and ranking of signs of excitation and depression in animal behaviour. Half of the metrizamide injections were made without anaesthesia, whereas the remaining injections were made during a short alphadolon/alphaxolon anaesthesia. EEG and animal behaviour were followed for 24 h after the injection of metrizamide. At the low 'clinical' dose, EEG could not detect statistically significant neurotoxicity, neither in anaesthetized nor in non-anaesthetized rabbits. Observation of animal behaviour, however, could detect statistically significant signs of depression in animals that had been anaesthetized. At the high dose level, both methods could detect significantly more serious symptoms of neurotoxicity than at the low dose level.

Anesthetics↗

PubMed1989

Serial EEG recordings following intrathecal metrizamide administration.

EEG recordings were obtained before and after intrathecal metrizamide injection in 50 consecutive patients who underwent metrizamide myelography or cisternography. EEG tracings were recorded daily until the pattern returned to baseline. One patient (2%) developed seizures. The most frequent EEG abnormality was generalized slowing of various degrees. In 15 patients (30%), the EEG record was normal throughout the study. In 4 patients (8%), EEG disturbances were seen up to the fifth day after the procedure. Patients who had undergone cervical myelography and cisternography had a marginally higher frequency of EEG disturbances than patients who underwent lumbar myelography. The causes inducing these time-related disturbances are discussed, as compared to pharmacokinetics of intrathecally administered metrizamide.

Adolescent↗

PubMed1984

Irreversible neurologic complications of metrizamide myelography.

Metrizamide, a major contrast agent for myelographic procedures, has rarely been reported to cause irreversible neurologic complications. The major transient neurologic alterations include neuropsychological reactions, generalized tonic-clonic seizures, and headaches. Two cases of irreversible spinal neurologic deficits resulting from metrizamide myelography are reported, and the factors that may increase the risks of complications in metrizamide myelographic studies are discussed, including preexisting dehydration, patient positioning, and the concentration of contrast agent.

Adult↗

PubMed1985

Comparison of metrizamide computed tomography and magnetic resonance imaging in the evaluation of lesions at the cervicomedullary junction.

We compared intrathecal metrizamide-enhanced CT (metrizamide-CT) and magnetic resonance imaging (MRI) in the evaluation of 17 patients with clinical suspicion of lesions at the cervicomedullary junction. MRI was superior in imaging the position of the cerebellar tonsils and the size and extent of mass lesions. MRI and metrizamide-CT were equal in detecting syringomyelia. CT with and without IV contrast enhancement was necessary to detect calcium or defects in the blood-brain barrier within neoplasms.

Adolescent↗