iothalamate-meglumine and Spinal-Diseases

Ionic contrast, if accidentally injected into the intrathecal space during routine imaging studies or interventional procedures, may significantly interfere with neuronal activity, potentially causing ascending tonic-clonic seizure syndrome and even death. As a result, ionic contrast is strictly contraindicated for intrathecal use. Rapid recognition of the condition followed by prompt management, typically involving aggressive cerebrospinal fluid (CSF) drainage, is critical to improving patient outcome. Lumbar drain has previously been well described as a management strategy.. We present a case of accidental intrathecal injection of an ionic contrast agent, iothalamate meglumine, in a patient undergoing cervical epidural steroid injection. This patient was managed successfully with drainage of CSF using an external ventricular drain alone.. Our literature review and analysis of the previously published cases demonstrate that aggressive CSF drainage is essential to improve outcomes, and in some cases an external ventricular drain alone may be effectively used.

Topics: Brain Diseases; Drainage; Evidence-Based Medicine; Female; Humans; Injections, Spinal; Iothalamate Meglumine; Medication Errors; Middle Aged; Pralidoxime Compounds; Spinal Diseases; Treatment Outcome; Ventriculoperitoneal Shunt

Magnetic resonance discography using gadolinium as an intradiscal contrast agent was investigated in a prospective study.. To evaluate the utility of magnetic resonance discography using gadolinium as an intradiscal contrast agent, as compared with the current standard of computed tomographic discography using intradiscal iodinated contrast agent.. Magnetic resonance arthrography with gadolinium has been used to evaluate shoulder, elbow, wrist, hip, knee, and other joints. Gadolinium has not been used as an intradiscal contrast agent. The authors' preliminary results using gadolinium as an intradiscal contrast agent for magnetic resonance discography were reported previously. They report the results of their completed study.. For this study, 42 disc levels were studied in 13 patients. Water-soluble iodinated contrast and gadopentetate dimeglumine were injected at each disc level. After discography, anteroposterior and lateral radiographs, computed tomography scans, and T1-weighted magnetic resonance imaging were performed. Six physicians interpreted the results from each disc level in a blinded fashion. Interscan and interobserver interpretation variability was determined for magnetic resonance discography and computed tomographic discography using the Pearson correlation-coefficient (r) test.. Interscan variability was highly correlated between computed tomographic discography and magnetic resonance discography when used to determine disc normality (r = 0.87), general degeneration (r = 0.87), anular fissure (r = 0.89), disc herniation (r = 0.92), and contrast leakage (r = 0.77). Interscan variability was assessed by the Pearson test, and all values of r for all the readers were noted to be statistically significant at P values less than 0.01. Interobserver variability was significantly correlated among the four more experienced readers (neuroradiologists and spine surgeons), but not among the spine fellows. Interobserver variability was also significantly correlated by computed tomographic (CT) and magnetic resonance imaging (MRI) discography for disc normality (CT r = 0.60; MRI r = 0.56), general degeneration (CT r = 0.76; MRI r = 0.71), anular fissure (CT r = 0.79; MRI r = 0.84), and disc herniation (CT r = 0.63; MRI r = 0.64). The readings for contrast leakage did not reach statistical significance for computed tomographic or magnetic resonance discography.. The high interscan and interobserver correlation rates obtained for magnetic resonance discography using gadolinium, as compared with the standard computed tomographic discography technique, indicate that magnetic resonance discography may be an acceptable substitute for the imaging of disc pathology. Magnetic resonance discography with gadolinium can be recommended for patients allergic to iodinated contrast agents and for patients who wish to limit their radiation exposure.

Topics: Contrast Media; Drug Administration Routes; Gadolinium DTPA; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Iothalamate Meglumine; Magnetic Resonance Imaging; Observer Variation; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Spinal Diseases; Tomography, X-Ray Computed

Nine asymptomatic volunteers underwent 40 provocative intra-articular injections of the thoracic zygapophyseal joints.. The purpose of the study was to isolate and stimulate the thoracic zygapophyseal joints via fluoroscopically guided intra-articular injections to determine whether they are potential pain generators.. Experimentally, the cervical and lumbar zygapophyseal joints have been shown to produce pain, and tentative referral patterns have been established. Referral patterns based on stimulation of the thoracic zygapophyseal joints have not been previously reported.. Four subjects underwent right-sided T3-T4, T5-T6, T7-T8, and T9-T10 joint injections, and four subjects underwent left-sided T4-T5, T6-T7, T8-T9, and T10-T11 joint injections. One subject underwent both the right- and left-sided joint injections. The zygapophyseal joints were injected with contrast medium only, and the quality, intensity, and distribution of evoked pain was recorded.. In this asymptomatic population, 72.5% of joints injected produced a sensation/pain that was different from the sensation of needle advancement through the soft tissues. In 27.5% of joints injected, there was no evoked pain despite adequate capsular distension. Evoked referral patterns were consistent in all subjects. Significant overlap occurred in the referral patterns, with most thoracic regions sharing 3-5 different joint referral zones.. This study provides preliminary confirmation that the thoracic zygapophyseal joints can cause both local and referred pain. A referral pain diagram has been constructed.

Topics: Adult; Back Pain; Female; Humans; Injections, Intra-Articular; Iothalamate Meglumine; Male; Pain Measurement; Spinal Diseases; Thoracic Vertebrae

Twenty-six patients with hydatid disease of bone were evaluated by means of radiography and conventional tomography. Fourteen patients underwent high resolution computed tomography (CT). In two patients with vertebral disease, magnetic resonance imaging (MRI) examination was also performed. Seventeen patients underwent surgery with histological examination in all. Based on the surgical data and gross examination of the specimen, the radiographic and CT findings have been reviewed to identify the most characteristic radiographic features and to assess the role of CT. Radiographic finding of hydatidosis are rarely typical in bone, and only in a few patients can CT contribute to the diagnosis. On the other hand, the local extension of the lesion both in bone and in soft tissues, which is essential in planning surgery, is always demonstrated well by CT.

Topics: Adolescent; Adult; Aged; Bone Diseases; Contrast Media; Echinococcosis; Female; Humans; Iopamidol; Iothalamate Meglumine; Male; Middle Aged; Osteolysis; Pelvic Bones; Spinal Diseases; Tomography, X-Ray Computed

One hundred and thirty-nine discs from cadaveric lumbar spines were injected with a mixture of radio-opaque fluid and dye. Discograms were taken and the discs were then sectioned in the sagittal plane. Examination of the sections revealed that injected fluid did not at first mix with the disc matrix but pushed it aside to form pools of injected fluid. The location of these pools, and hence the appearance of a discogram, depended on the stage of degeneration of the disc. It is concluded that useful clinical information can be obtained from discograms.

Topics: Adolescent; Adult; Child; Coloring Agents; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Middle Aged; Radiography; Spinal Diseases

Topics: Adolescent; Adult; Aged; Child; Constriction, Pathologic; Female; Humans; Iodobenzenes; Iophendylate; Iothalamate Meglumine; Lumbar Vertebrae; Male; Middle Aged; Myelography; Spinal Diseases

Topics: Adult; Contrast Media; Female; Humans; Iothalamate Meglumine; Male; Middle Aged; Myelography; Solubility; Spinal Diseases; Water

Myelography was performed on 80 monkeys to study postmyelographic arachnoiditis. Metrizamide myelography caused arachnoiditis when high concentrations were used, but not with the usual clinical concentrations. Arachnoiditis resulted after myelography with meglumine iocarmate; however, the risk of arachnoiditis was reduced by diluting the contrast medium. Prophylactic intrathecal methylprednisolone was not effective in preventing arachnoiditis. Blood in the cerebrospinal fluid did not affect the degree of arachnoiditis.

Topics: Animals; Arachnoiditis; Disease Models, Animal; Haplorhini; Iothalamate Meglumine; Methylprednisolone; Metrizamide; Myelography; Spinal Diseases

Convulsions and fracture of the neck of the femur following myelography with Conray and Dimer X are reported in two patients with a gross post-tuberculous gibbus deformity of the thoracic spine. The possible causes of the increased risk associated with myelography of the patients with gibbus are discussed.

Topics: Femoral Neck Fractures; Humans; Iothalamate Meglumine; Male; Middle Aged; Myelography; Seizures; Spinal Diseases

Topics: Humans; Iothalamate Meglumine; Lumbosacral Region; Myelography; Spinal Diseases

We have taken myelograms of six patients with grave post-tuberculous thoracic gibbus of the spine and gross deformity of the thoracic cage. Two of these patients suffered violent convulsions and fracture of the neck of the femur. In one patient the myelogram was taken with Conray Meglumine and in another with Dimer X. We suggest that a grave deformity of the thoracic cage is a relative contraindication for lumbar myelography with these water-soluble contrast media. We assume that the reduced tissue oxygenation in these patients results in a lower threshold for convulsions.

Topics: Femoral Neck Fractures; Humans; Iothalamate Meglumine; Metrizamide; Myelography; Seizures; Spinal Diseases; Spine

Experience with Dimer-X myelography in 3000 patients provides some indication of the scope of examination of the lumbar, thoracic and cervical segments of the spinal canal with a water-soluble contrast medium. Myelography with any contrast medium should only be applied for serious indications, and never as an outpatient procedure, for the patient requires careful after-treatment. However, the routine use of myelography may offer the best insurance against the disappointment and embarrassment of surgery by trial and error. The application of a careful, standardized technique makes it possible to obtain accurate information about the whole spinal canal and to avoid the danger of the false results to which examination with oily media are liable at all levels. The development of ever safer contrast media may help to limit the problem of spinal fibrosis, which is not a rare complication of myelography and spinal surgery.

Topics: Child; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Myelography; Premedication; Spinal Diseases; Subarachnoid Space

Our experience with 451 water soluble myelograms has been presented. We feel that the advantages exceed the disadvantages and that a water soluble medium is essential for a truly diagnostic myelographic study.

Topics: Humans; Iothalamate Meglumine; Iothalamic Acid; Myelography; Solubility; Spinal Diseases