Lumbar myelography with Conray Meglumin 282. Report of 100 investigations with special reference to the adverse effects

Magnetic resonance imaging contrast media in the subarachnoid space. A comparison between gadodiamide injection and gadopentetate dimeglumine in an experimental study in pigs

RATIONALE AND OBJECTIVES

The authors studied the neural tolerance and contrast enhancement of a nonionic, gadodiamide injection (gadolinium [Gd]-DTPA-BMA), and an ionic, gadopentetate dimeglumine (Gd-DTPA), contrast medium in the subarachnoid space of the pig.

METHODS

Sixteen experiments were performed in eight pigs. Lumbar and lateral C1-C2 punctures were performed. Ten milliliters of Gd-DTPA-BMA or Gd-DTPA with Gd concentrations varying from of 500 mmol/L to 0.625 mmol/L were injected, in four experiments via the lumbar route and in 12 experiments via the C1-C2 puncture.

RESULTS

Four pigs injected via the C1-C2 puncture with a Gd concentration of 500 mmol/L had signs of somatomotor irritation and all were paretic after 24 hours. No somatomotor effects were observed in the other experiments, where lower concentrations of Gd were used. Marked enhancement of the cerebrospinal fluid with no visible signal differences was obtained with concentrations from 10 to 0.625 mmol/L.

CONCLUSIONS

Both Gd-DTPA-BMA and Gd-DTPA are remarkably well tolerated in the subarachnoid space. In doses relevant for imaging purposes no adverse effects were seen.

Leptomyelolipoma: analysis of 20 cases

Leptomyelolipoma (lumbosacral lipoma) is a common form of spinal dysraphism. The deficits produced include sensory, motor, bowel, and bladder dysfunction, and vary in incidence between the pediatric and adult populations. Twenty patients treated surgically at the Mount Sinai Hospital between 1972 and 1988 are reviewed. Fifty percent were 12 years of age or less and 50% were older than 18 years of age. The surgical approach was designed to accomplish untethering of the conus medullaris, debulking of the lipomatous mass compressing the cord, reconstruction of the dural canal, and reapproximation of the paraspinal muscles and lumbosacral fascia to prevent future trauma. Postoperatively, no patient experienced deterioration of neurological function. Of the symptomatic patients. 67% displayed dramatic improvement or became asymptomatic and 33% experienced stabilization of their deficits. The symptoms most resistant to surgical correction were orthopedic foot deformities and bowel dysfunction, whereas bladder dysfunction, motor weakness, and radiculopathies were most amenable to surgical therapy. Early surgical repair is recommended in these cases to forestall irreversible neurological damage.

Sex and age related differences in postmyelographic adverse reactions. A prospective study of 1765 myelographies

Differences in frequency of postmyelographic adverse reactions were analyzed with respect to sex and age in a prospective study including 1026 patients injected with metrizamide and 739 injected with iohexol. Regardless of the type of contrast medium or myelography, all types of adverse reactions were 1.4-3.8 times as frequent in women as in men. Most of the differences were statistically significant. Headache was more frequent, while vomiting and dizziness were less frequent in both women and men aged 26-50 years compared with those over 50 years of age. Dizziness and increased low back pain were consistently reported spontaneously by the patients less frequently than emerged via formal interview. The large differences between the sexes suggest that further research on contrast media toxicity would be best performed with separation of the data by gender.

Myelography with iohexol (Omnipaque); a clinical report with special reference to the adverse effects

One thousand myelographies (370 cervical, 77 thoracic and 553 lumbar examinations) with iohexol (Omnipaque) were performed in 922 patients. No convulsions were seen. Transient hallucinations were reported in one patient. Headache occurred in 38%. The highest frequency of headache (52%) was reported following cervical myelography with lumbar puncture technique, placing the patient horizontally after the examination. The lowest frequency (20%) occurred following cervical myelography with the C1-C2 puncture technique, placing the patient in bed with the head end elevated 20 degrees. Lumbar myelography was performed on an out-patient basis in 243 patients. The frequency of headache was slightly higher (49%) in this group than in the other lumbar myelography patients (34-44%), but no serious complications were seen.

The epileptogenicity of neurolept anaesthesia in patients during and after neuroradiological examinations with metrizamide

Previous experimental studies caution against the use of neurolept anaesthesia during subarachnoid injection of metrizamide for neuroradiodiagnostic procedures because of severe epileptogenic complications. To examine whether these recommendations are relevant in the clinical situation or not, 104 patients were studied. They underwent neuroradiological investigations with metrizamide subarachnoidally and were anaesthetized with neurolept anaesthesia either during the investigation (59 patients, Group I) or within 48 h afterwards (45 patients, Group II) when a neurosurgical operation was performed. In 10 patients of Group I, EEG was recorded during the investigation. All patients were observed for occurrence of clinical epileptic manifestations during and after the anaesthesia. Apart from one patient who had a short episode of suspected epileptogenic EEG-activity shortly after the injection of metrizamide, none of the other patients showed EEG-abnormalities of epileptogenic type and none of them had any clinical signs of epileptic manifestations. On the basis of the results of this clinical study it is concluded that neurolept anaesthesia does not increase the risk of epileptic complications during neuroradiological investigations with metrizamide.

Bilateral femoral neck fractures as a complication of myelography

This paper discusses two cases of bilateral subcapital fracture of the proximal femur as a complication of myelography with Conray 60. The literature is reviewed.

Cervical metrizamide myelography by lumbar puncture

Cervical myelography with metrizamide administered by a lumbar puncture is described. Diagnostic information in the cervical region was obtained in 8 of the 8 patients studied. No major complications were encountered.

Influence of the cation on the side-effects of urographic contrast media

The incidence of side-effects produced by meglumine diatrizoate and meglumine-, meglumine-calcium-, and sodium-calcium-magnesium metrizoate, was compared in 800 urographies. Patients older than 60 years seem to have less side-effects than younger patients. The incidence of sensation of warmth seems to be higher in patients who have had previous urographies, compared to those who are examined for the first time. The incidence of this effect is higher for the sodium-calcium-magnesium salt of metrizoate, than for other salts of metrizoate.

Metrizamide in radiography of the central nervous system. A preliminary report

Metrizamide seems to be a suitable contrast medium for ventriculography and myelography. This contrast medium is less toxic and far less epileptogenic and spasmogenic than the other water-soluble contrast media in current use. No serious complications were noted in the present series. Transient changes in EEG were recorded, mainly with cervical myelographies. However, it is too early to evaluate the long-term side effects.

Metrizamide-phenothiazine interaction. Report of a case with seizures following myelography

One single clinical complication of grand mal seizures in conjunction with the subarachnoid administration of the new non-ionic contrast medium metrizamide is reported in a patient who had been taking chlorpromazine. An interaction between the contrast medium and phenothiazine derivatives is considered probable.