CNS-Effects from Subarachnoid Injections of Iohexol and the Non-Ionic Dimers Iodixanol and Iotrolan in the Rabbit

Sundgren, Pia C.; Bååth, Lars B.; Maly, Pavel

doi:10.1177/028418519503600319

Cited by 10 publications

(1 citation statement)

References 12 publications

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“…22 The reported cases of postmyelographic seizure with nonionic, watersoluble contrast in the past decade have been very rare. Although animal studies have shown iopamidol to be more epileptogenic than metrizamide 45 and the excitative neurotoxic potential of iodixanol, 46 clinical trials of these newer nonionic agents have shown them to be safe and effective, with fewer adverse effects than metrizamide. 8,16,22,47 The risk of seizure with the currently used contrast media is reported to be in the range of 0.093%-0.847%.…”

Section: Discussionmentioning

confidence: 99%

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision

Shah

Kranz

Anzai

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Patient preparation for myelography and postprocedural monitoring varies widely between practices, despite published guidelines. Our aim was to examine the current practice variations in discontinuing reportedly seizure thresholdlowering medications before myelography and to assess the reported incidence of postmyelographic seizures. MATERIALS AND METHODS: An e-mail survey was sent to American Society of Neuroradiology members concerning the number of postmyelographic seizures experienced in the past 5 years, the presence of an institutional policy for discontinuing seizure threshold-lowering medications, and the type of myelographic contrast used. We compared the postmyelographic seizure frequency in the responses. RESULTS: Of 700 survey responses, 57% reported that they do not discontinue seizure threshold-lowering medications before myelography. Most (97%) indicated never having a patient experience a seizure following myelography. The number of postmyelographic seizures between those who discontinue seizure threshold-lowering medications and those who do not was not statistically significant (OR ϭ 2.13; 95% CI, 0.91-4.98; P ϭ .08). Most (95%) reported using nonionic hypo-osmolar agents. CONCLUSIONS: Survey results revealed widely variable practices for patient myelography preparation and postprocedural monitoring. We found no difference in reported seizures between those who discontinued seizure threshold-lowering medications and those who did not. In light of our findings, we propose that discontinuing reportedly seizure threshold-lowering medications is not warranted with the current nonionic water-soluble contrast agents and may be potentially harmful in some instances. This work supports revision of existing recommendations to withhold such medications before myelography.

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Section: Discussionmentioning

confidence: 99%

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision

Shah

Kranz

Anzai

et al. 2018

AJNR Am J Neuroradiol

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Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

Mizuno

Gauss

Suzuki

et al. 2007

Can J Anesth/J Can Anesth

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CAN J ANESTH 54: 1 www.cja-jca.org Januar y, 2007Purpose: We describe a complication of epiduroscopy with encephalopathy and rhabdomyolysis associated with the contrast medium iotrolan. Clinical features:A 76-yr-old man with failed back surgery syndrome underwent epiduroscopy. Sufficient lysis could not be achieved in the epidural space above the level of L 4 due to dense adhesions and scar tissue. After epidural injections of iotrolan and mepivacaine, he developed motor weakness and hypoesthesia in both legs, which lasted for three hours. He also became confused, agitated, disoriented, and developed neck stiffness and tremors involving the head and legs. Computed tomography revealed diffuse contrast enhancement within the intracranial cerebrospinal fluid (CSF) spaces, indicating an intraoperative dural tear. Marked increases in serum creatinine phosphokinase and myoglobin indicated subsequent acute rhabdomyolysis. Crystalloid infusion and semi-recumbent positioning facilitated iotrolan absorption from the CSF, and the patient recovered uneventfully. Conclusions:Dural tear during epiduroscopy may allow access of contrast media into the CSF. Neurotoxicity secondary to iotrolan within the CSF was a likely contributing factor to the encephalopathy and subsequent rhabdomyolysis. This is an instructive example of the importance of diagnosing inadvertent dural tear during epiduroscopy under iotrolan, for avoidance of adverse events such as encephalopathy and rhabdomyolysis. Eléments cliniques : Un homme de 76 ans présentant des séquelles d'un échec d'une chirurgie aux rachis a subi une épidur-oscopie. Une lyse suffisante n'a pas pu être obtenue dans l'espace péridural au-dessus de L 4 à cause d'adhésions denses et de tissus cicatriciels. Suite à des injections péridurales d'iotrolan et de mépivacaïne, il a développé une parésie ainsi qu'une hypoesthésie au niveau des membres inférieurs qui durèrent trois heures. Il est également devenu confus, agité, désorienté, et a développé une raideur du cou et des tremblements de la tête et des jambes. La tomodensitométrie a révélé un rehaussement diffus du produit de contraste dans les espaces intracrâniens du liquide céphalo-rachidien (LCR), indiquant

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Myelography with a dimeric (iodixanol) and a monomeric (iohexol) contrast medium: a clinical multicentre comparative study

Skalpe¹,

Bonneville

Grane

et al. 1998

European Radiology

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The purpose of this study was to evaluate and compare the radiographic efficacy and safety of iodixanol (Visipaque; 270 and 320 mg I/ml) and iohexol (Omnipaque; 300 mg I/ml) in myelography. The study was randomized, double-blind and comparative including 398 patients from five European university clinics. The radiographic visualisation was evaluated as poor, good or excellent. Adverse events were recorded by interviewing the patients after the myelography, and each patient was given a questionnaire to be returned after 1 week. In cervical myelography with cervical puncture more films with excellent quality was obtained after iodixanol 320 mgI/ml compared with iohexol 300 mgI/ml (p = 0.009). Also in lumbar myelography iodixanol 320 mgI/ml compared favourably with iohexol 300 mgI/ml (p = 0.006). The most frequent adverse event was headache, which occurred in 5-35 % of patients during the first 24 h and in 19-61 % within the first 7 days, depending on the centre. There was no difference in frequency and severity of the adverse effects between the contrast media.

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CNS-Effects from Subarachnoid Injections of Iohexol and the Non-Ionic Dimers Iodixanol and Iotrolan in the Rabbit

Cited by 10 publications

References 12 publications

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision

Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy

Myelography with a dimeric (iodixanol) and a monomeric (iohexol) contrast medium: a clinical multicentre comparative study

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