Lumbar myelography with metrizamide—a new non-ionic contrast medium

Abstract

In contradistinction to all currently available water-soluble contrast media, metrizamide (Amipaque) is not a salt, but a substituted amide and therefore does not dissociate in solution. This unique property results in solutions of high iodine content yet with low osmolality. Metrizamide probably has a lower neurotoxicity than any other known water-soluble contrast agent. A clinical trial of metrizamide lumbar myelography in 201 patients in three clinical centres represents the first clinical assessment of this new contrast medium in the United Kingdom. The technique of the radiological procedure and the adverse reactions encountered are presented and discussed. There were no serious adverse effects: no muscle spasm or epilepsy. Minor adverse reactions--headache, vomiting and nausea occur with approximately the same frequency as with meglumine iocarmate: 43 percent of patients complained of headache. In 118 patients, the lower dorsal subarachnoid space was also examined with no increase in toxic reactions. It is concluded that metrizamide is a safe contrast medium for lumbar and lower dorsal myelography. Water-soluble media will probably largely replace oil products for these investigations. Further clinical trials are being extended to include examination of the upper dorsal and cervical subarachnoid space.

Confusion, Dysphasia, and Asterixis Following Metrizamide Myelography

“…The second pattern was evident as early as four hours after myelography and consisted of spikes, sharp waves, atypical spike and wave patterns, and intermittent rhythmic frontal delta activity. Three percent of their patients had seizures, compared with 0.4% in Nickel's series (1977) and none in Grainger's (1976). Seizures are felt to be due to the direct toxic effect of metrizamide upon the cerebral cortex.…”

“…EEG abnormalities, CSF abnormalities, and seizures after metrizamide myelography have been of some concern. Grainger (1976) reported 16% of patients after metrizamide myelography had EEG abnormalities. In Instam and Sellden's series (1976), EEG abnormalities occurred in 8% with some bursts seen but no definite paroxysmal activity.…”

“…Anxiety, confusion, and hallucinations occurred in thirteen patients and lasted a few hours, but no further details were given. Grainger (1976) reported headaches following myelography in 43% but nausea and vomiting in only 12%. Hyperacusis and transient hallucinations occurred but were not considered major problems.…”

“…Despite these advantages, significant side effects have occurred. These side effects have included transient hallucinations (Eldevik, Nakken, et al, 1978;Grainger, Kendall, et al, 1976;Sortland, Lundervold, et al, 1977), hyperacusis (Grainger, Kendall, et al, 1976), seizures (Sortland, Lundervold, et al, 1977;Lundervold and Sortland, 1977;Nickel and Salem, 1977), significant electroencephalographic (EEG) abnormalities (Sortland, Lundervold, et al, 1977;Lundervold and Sortland, 1977;Skalpe, Tabergsen, et al, 1973;Kaada, 1977;Skalpe, 1975Skalpe, , 1977, areflexia (Buruma and Hekster, 1977), cerebrospinal fluid ( C S F ) pleocytosis (Grainger, Kendall, et al, 1976;Skalpe, 1977), nausea, vomiting (Eldevik, Nakken, et al, 1978;Grainger, Kendall, et al, 1976;Nickel and Salem, 1977), and confusion (Eldevik, Nakken, et al, 1978;Sortland, Lundervold, et al, 1977;Koerner, 1979). We report a patient in whom a prolonged confusional state, dysphasie speech, includ-ing echolalia and perseveration, and striking asterixis followed metrizamide myelography.…”

Total myelography with metrizamide through the lumbar route

“…Metrizamide, a water-soluble, nonionic contrast agent for myelography, has received wide acceptance [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Although lumbar myelography has been its major application, its use for cervical and dorsal myelography is less enthusiastically accepted.…”