Complications of Metrizamide Myelography

Killebrew, Kate; Whaley, Robert A.; Hayward, James N.; Scatliff, James H.

doi:10.1001/archneur.1983.04050020040007

Cited by 28 publications

(3 citation statements)

References 20 publications

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“…33,34 Complications from metrizamide are often dose-related, resulting from excessive intracranial concentrations of the drug. 12,18,[35][36][37][38] The mechanism of metrizamide neurotoxicity is postulated to be cerebral glucose metabolism interference. 11,37,39 The recognized risk factors for metrizamide myelography were seizure disorder, STLMs, dehydration, diabetes, and age, 40 and these risk factors were not dose-dependent.…”

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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“…Myelography and CT have been the standard methods for demonstrating degenerative spondylosis and herniated disks. The complications and patient discomfort inherent in intrathecal injection of contrast medium and subsequent imaging are well established [1][2][3][4][5][6][7]. MR imaging of the cervical spine is being used with increasing frequency to study these patients [8][9][10][11].…”

Section: Gradient Echo (Grass) Mr Imaging In Cervical Radiculopathymentioning

confidence: 99%

Gradient echo (GRASS) MR imaging in cervical radiculopathy

Hedberg

Drayer

Flom

et al. 1988

American Journal of Roentgenology

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“…Metrizamide compared favorably with iodophendylate because it resorbed with the CSF, but it was well-known to carry a non-negligible risk of neurologic symptoms, including seizure, with intrathecal administration. 4 Since the advent of second-generation, nonionic water-soluble contrast agents such as iohexol, myelography-related seizure activity has become a very rare event. There have been only scattered individual case reports of seizures occurring in patients undergoing myelography with these agents, and most of these case reports had extenuating circumstances such as a history of epilepsy or an overdosage of the intrathecal contrast agent.…”

mentioning

confidence: 99%

It Is Not Necessary to Discontinue Seizure Threshold–Lowering Medications Prior to Myelography

Krupa

Salts

Mihlon

2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: There is no consensus on whether patients undergoing myelography should discontinue medications that could lower their seizure threshold. The purpose of this study was to document the most commonly prescribed seizure thresholdlowering medications in patients undergoing myelography and determine whether withholding such medications decreases the incidence of seizures. MATERIALS AND METHODS: We performed a retrospective observational study of all the myelograms obtained in 2016 at 2 affiliated hospitals. At hospital A, seizure threshold-lowering medications are discontinued before myelography, and prophylactic diazepam is given for all cervical myelograms. At hospital B, seizure threshold-lowering medications are not withheld before the procedure, and medical seizure prophylaxis is not implemented. The seizure threshold-lowering medications the patients were taking at the time of the procedure and postmyelographic seizure incidence were documented. RESULTS: A total of 311 patients underwent myelography during 2016. One hundred eleven patients (36%) were on at least 1 seizure threshold-lowering medication, and 30 (10%) were on at least 2. The most common medications were duloxetine, sertraline, venlafaxine, bupropion, and trazodone. The most common tricyclic antidepressant was amitriptyline. Three patients across both sites had a controlled seizure disorder and were on antiepileptics. None of the patients at either hospital had seizures during or within 3 hours following any of the myelograms during the study period. CONCLUSIONS: Continuing seizure threshold-lowering medications during myelography does not increase the risk of seizures. Screening for and withholding seizure threshold-lowering medications are not indicated for routine myelography.

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Complications of Metrizamide Myelography

Cited by 28 publications

References 20 publications

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

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

Gradient echo (GRASS) MR imaging in cervical radiculopathy

It Is Not Necessary to Discontinue Seizure Threshold–Lowering Medications Prior to Myelography

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