Leptomeningeal changes following lumbar myelography with water-soluble constrast media (Meglumine iothalamate and methiodal sodium)

Intraspinal arachnoiditis and hydrocephalus after lumbar myelography using methylglucamine iocarmate.

“…Previously, the development of these leptomeningeal adhesions has only been demonstrated in the lower dural sac (Autio et al, 1972;Halaburt and Lester, 1973;Irstam and Rosencrantz, 1973;Suolanen, 1975), which is related to the fact that these media have been used exclusively in the lumbar region.…”

“…However, like the oily contrast media, these agents are more or less neurotoxic, and various complications may be observed after myelography with water-soluble contrast agents. In recent years delayed adhesive arachnoidal changes after the use of these substances have been reported more frequently (Autio et al, 1972;Ahlgren, 1973Ahlgren, , 1975Halaburt and Lester, 1973;Irstam and Rosencrantz, 1973). All arachnoidal changes observed to date have been located exclusively in the caudal region of the spinal canal (Ahlgren, 1973;Halaburt and Lester, 1973;Irstam and Rosencrantz, 1973;Slatis et al, 1974).…”

“…In recent years delayed adhesive arachnoidal changes after the use of these substances have been reported more frequently (Autio et al, 1972;Ahlgren, 1973Ahlgren, , 1975Halaburt and Lester, 1973;Irstam and Rosencrantz, 1973). All arachnoidal changes observed to date have been located exclusively in the caudal region of the spinal canal (Ahlgren, 1973;Halaburt and Lester, 1973;Irstam and Rosencrantz, 1973;Slatis et al, 1974). This paper describes an unusual case of intracranial and midthoracic arachnoiditis in which the clinical symptoms appeared shortly after lumbar myelography with the water-soluble contrast medium meglumine iocarmate.…”

“…Among these the most common are acute or chronic leptomeningeal reactions (Autio et al, 1972;Ahlgren, 1973;Halaburt and Lester, 1973;Irstam and Rosencrantz, 1973).…”

The changing pattern of spinal arachnoiditis.

“…The water-soluble contrast media are not free from this complication (Autio et al, 1972;Ahlgren, 1973;Halaburt and Lester, 1973;Radberg and Wennberg, 1973;Rosencrantz, 1973, 1974;Liliequist and Lundstrom, 1974;Slatis et al, 1974;Malmros, 1976). Though various authors (Ahlgren, 1973;Halaburt and Lester, 1973;Irstam and Rosencrantz, 1974) have claimed that the incidence varies between the different contrast media, Malmros's composite figures suggest little difference between methiodal (Kontrast U), methylglucamine iothalamate (Dimer-X), and meglumine iothalamate (Conray 60). An increasing amount of contrast medium, and hence concentration in the cerebrospinal fluid, results in an increased incidence of severe arachnoiditis (Halaburt and Lester, 1973).…”