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 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors present the results of own investigations on the occurrence of side effects following myelography with the contrast medium Amipaque administered usually by the lumbar route. Sixty patients aged 21-65 years with various diseases of the spinal cord and cauda equina were studied. Clinical and myelographic investigations were performed before and after myelography. In 6 out of 60 cases (10%) transient neurological disturbances developed including epileptic seizures, speech disturbances of the type of aphasia and dysartria, visual disturbances and twitching of lower extremities. Other symptoms and signs included: headaches, vomiting, collapse. One patient with cardiorespiratory failure died hours after myelography with evidence of increased symptoms of cardiorespiratory failure. EEG changes appeared after myelography in 2/3 of cases and persisted for up to 12 days. The authors call attention to the high proportion of neurological complications and EEG changes which must be taken into account when indications to myelography are considered. Particular caution is necessary in cases with coexistent cardiorespiratory failure.
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PMID:[Clinical and electroencephalographic signs of side effects in patients after myelography using "amipaque"]. 404

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.
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PMID:Metrizamide: a review with emphasis on drug interactions. 610 72

A randomised blind trial comparing Iopamidol (Niopam) and Metrizamide (Amipaque) for lumbar radiculography was performed in 100 patients. Significantly more patients receiving Metrizamide complained of having severe headaches (P less than 0.05) and vomiting (P less than 0.05). There was no difference in quality of the radiculograms.
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PMID:A randomized blind trial of iopamidol (Niopam) and Metrizamide (Amipaque) in lumber radiculography. 633 15

In a prospective double-blind randomized study involving 40 patients undergoing lumbar myelography, an attempt was made to correlate adverse effects of the examination with contrast medium dosage. Metrizamide for myelography is dispensed in two dosage aliquots, 3.75 and 6.75 g. In one group of 20 patients (10 males and 10 females) the higher dose was utilized routinely, in a second similar group the lower dose. 24 h after myelography complaints of headache were noted in 9 out of 40 patients; nausea, sometimes with vomiting, in 3 out of 40, and giddiness or light-headedness in 6 out of 40. No other side effects were registered. Complaints after myelography occurred significantly more often in females than in males, but there was no correlation between the incidence of complaints and the dose of metrizamide administered.
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PMID:Relationship between contrast medium dose and adverse effects in lumbar myelography. 638 Aug 85

Spontaneous ventriculocisternostomy rarely occurs in obstructive hydrocephalus. The authors experienced a case of spontaneous ventriculocisternostomy diagnosed by CT scan with metrizamide and Conray. Patient was 23-year-old male who had been in good health until one month before admission, when he began to have headache and tinnitus. He noticed bilateral visual acuity was decreased about one week before admission and vomiting appeared two days before admission. He was admitted to our hospital because of bilateral papilledema and remarkable hydrocephalus diagnosed by CT scan. On admission, no abnormal neurological signs except for bilateral papilledema were noted. Immediately, right ventricular drainage was performed. Pressure of the ventricle was over 300 mmH2O and CSF was clear. PVG and PEG disclosed an another cavity behind the third ventricle, which was communicated with the third ventricle, and occlusion of aqueduct of Sylvius. Metrizamide CT scan and Conray CT scan showed a communication between this cavity and quadrigeminal and supracerebellar cisterns. On these neuroradiological findings, the diagnosis of obstructive hydrocephalus due to benign aqueduct stenosis accompanied with spontaneous ventriculocisternostomy was obtained. Spontaneous ventriculocisternostomy was noticed to produce arrest of hydrocephalus, but with our case, spontaneous regression of such symptoms did not appeared. In the literature, arrest of hydrocephalus was noted in 50 per cent of 14 cases of obstructive hydrocephalus with spontaneous ventriculocisternostomy. By surgical ventriculocisternostomy (method by Torkildsen, Dandy, or Scarff), arrest of hydrocephalus was seen in about 50 to 70 per cent, which was the same results as those of spontaneous ventriculocisternostomy. It is concluded that VP shunt or VA shunt is thought to be better treatment of obstructive hydrocephalus than the various kinds of surgical ventriculocisternostomy.
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PMID:[Case of spontaneous ventriculocisternostomy: with special reference to a CT finding]. 660 89

The patient, 64-year-old female, had episode of sudden attack of severe vertigo, headache, nausea, and vomiting which lasted for about twenty minutes on May 20th in 1980. She had hypertension, polyp of stomach, diverticuli of duodenum in her past history. Neurological examination on her admission revealed fine horizontal nystagmus on bilateral gaze and slight clumsy movement on left F-N test. On plain skull and cervical X-P, atlanto-occipital fusion and Klippel-Feil syndrome (C2-C3 fusion) were seen. Plain CT scanning revealed a large cystic lesion which extended from the vermis to the left cerebellar hemisphere. No enhanced area was seen. The forth ventricle was seemed to be enlarged. And the left-sided dorsal part of the forth ventricle attached to the cyst. Metrizamide CT cisternogram showed there was no direct communication between them. Angiographically, the vertebrobasilar arteries were noted sclerotic changes and poor vascularities in the left cerebellar hemisphere was noted. On opening the dura during surgery, the left cerebellar hemisphere appeared bulging state and the bilateral cerebellar tonsils were hypoplastic. Outer thin membrane of the cyst was removed. The cyst has no communication with the subarachnoid space as well as with the forth ventricle. The cystic fluid was slightly yellowish, but had no Froin's sign. Reddish-gray color nodular area, which seemed to be similar to mural nodule macroscopically, was noted in the area of inner surface of the cyst. This part was removed. Histological findings of this area showed abnormal architecture with malarranged layer of cerebellar cortex.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cerebellar cyst associated with cytoarchitectonic abnormalities in the cerebellar cortex]. 662 88

A clinical assessment of metrizamide (Amipaque) lumbar myelography in 150 patients is reported, and the adverse reactions encountered are presented and discussed. Minor adverse reactions--headache (48%), nausea (10%) and vomiting (7%)--were common, and the incidence reflected overseas experience. Severe headache occurred in a significant proportion of patients (20%), despite adequate hydration and the use of a small-gauge needle. There were no major adverse reactions such as epilepsy or severe muscle spasm. The study suggests that metrizamide is well tolerated, gives good anatomical demonstration and should replace iophendylate (Myodil) in this region. Recent reports of occasional, but sometimes severe, neurological complications indicate that further cautious assessment is required.
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PMID:Lumbar myelography today. Experience with metrizamide, a water-soluble, non-ionic contrast medium. 701 91

Thirty-four patients were submitted to the conventional cervical myelography by administration of metrizamide (Amipaque) through three routes (lumbar 23, suboccipital 6, C1-C2 lateral 5). After the injection of metrizamide (4-11 ml, 170-250 mgI/ml), all procedures of the cervical myelography were done as soon as possible within 9 minutes. The adverse reactions of Amipaque were observed in 29 cases (85%) out of 34 cases initially 1 hour after cervical myelography and disappeared completely in an average of 16 hours. The total number of the side effects was 140 incidences such as meningeal irritation (headache 18, nausea 17, vomiting 17), cerebellar signs (dizziness 11, dysarthria 8, tremor 5, bradylalia 2, dysmetria 2, tipsy feeling 2, dysdiadochokinesis 1), autonomic signs (flushing 7, pale face 4, fever 4, sweating 2, hiccup 2, fatigability 2, micturition disturbance 1), sensory signs (exacerbation of numbness 6, perioral numbness 3, back pain 1, chest pain 1), motor signs (focal muscle spasm 5, exacerbation of paresis 4, areflexia 1), psychiatric signs (dysphasia 3, disturbance of consciousness 2, euphoria 1, persecutory delusion 1) and muddiness 7. We observed that waxing and waning of side effects correlated tightly with transient cortical penetration of dye in CT and cortical dysfunction mainly slowing of the background activity and slow wave burst in EEG. According to high frequency of side effects in our study, we suggest that a greater incidence of side effects may result when high concentration of Amipaque comes in contact with the cerebral cortex by using an inadequate fluoroscopic table which has only fixed one plane image and rough positioning control. Slow absorption into blood stream may affect appearance and maintenance of side effects. In order to decrease side effects after Amipaque cervical myelography, we propose that we should introduce a mobile rotating chair coupled with high power image and chose C1-C2 lateral route using 1500-1700mgI of Amipaque.
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PMID:[Side effects of metrizamide (Amipaque) cervical myelography (author's transl)]. 711 May 15

In 320 cases contrast investigations of the vertebral column were carried out injecting by lumbar tap Metrizamide in 174 cases and Amipaque in 126 cases. In 259 cases the investigation was limited to the lumbar part, in 25 cases to the thoracic part, and in 19 cases to the cervical part of the spine. In 12 cases the whole vertebral canal was explored in this way. In 5 cases only epidurography was done. Very good or good contrast filling of the dural sac was obtained in the thoracolumbar segment using contrast medium 200 mg I/ml. In some cases this degree of concentration was inadequate for good visualization of the cervical segment. Side effects included headaches in 52%, nausea in 15%, vomiting in 4% of cases. In 28% of cases fever up to 38 degrees C was observed on the first day after the procedure. In 8 cases of repeated radiculography no evidence of arachnitis was demonstrated.
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PMID:[Radiodiagnosis of the spinal canal using a nonionic contrast medium]. 734 2

A case of Iotrolan encephalopathy is reported. A 66-year-old woman, suffering from subarachnoid hemorrhage, was admitted to our department on January 17th, 1995. After an operation for aneurysmal clipping and ventriculo-peritoneal shunt, she was discharged with no neurological deficiency. CT scan revealed ventricular enlargement and slight periventricular lucency. She was re-admitted on January 4th, 1996. She was suffering from nausea, vomiting, right hemiparesis, right hemi-hypesthesia and disturbance of consciousness. CT scan demonstrated right thalamic bleeding and bilateral ventricular hemorrhage. Further ventricular enlargement was also revealed. With medical treatment, her symptoms were relieved gradually. But disorientation and memory disturbance continued. Shuntography with Iotrolan was performed on February 2nd, 1996. The ventriculo-peritoneal shunt was demonstrated to be occluded on the abdominal side. The volume of Iotrolan used was about 8cc. She became very restless on the night of the examination. Her temperature was up to 38. CT on February 4th demonstrated brain penetration of the Iotrolan. Revision of ventriculo-peritoneal shunt, administration of steroids and hydration was performed. CSF findings demonstrated no abnormalities. Her symptoms were relieved gradually. Iotrolan is a non-ionic contrast media of dimer type, composed of C37 H48 I6 N6 O18. Its distinctive features are low distributing coefficient and high affinity with water. Contrasting several reports of Metrizamide encephalopathy, only 2 cases of Iotrolan encephalopathy were reported. Iotrolan is reported to be much safer than Metrizamide. We were able to find brain penetration by Iotrolan. It is expected to be a characteristic radiological finding of encephalopathy induced by contrast media. The mechanism of Iotrolan encephalopathy is obscure. Several theories concerning Metrizamide encephalopathy are proposed. These are (1) inhibition of hexokinase, (2) inhibition of acethylcholinesterase, (3) immunological mechanism and (4) vascular disturbance. Iotrolan has no 2-deoxy-glucose structure. The inhibition theory of hexokinase is least expected. Related matters are circulatory disturbance of liquor, dehydration, excessive contrast media, advanced age, diabetes mellitus, hypertension, epileptic patients and patients taking phenothiazines. Prompt therapy is important. Removal of contrast media, hydration and administration of steroids should be performed as early as possible.
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PMID:[A case of Iotrolan encephalopathy]. 893 76


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