metrizamide and Anaphylaxis

Topics: 4-Aminobenzoic Acid; Adult; Anaphylaxis; Animals; Contrast Media; Diatrizoate; Dose-Response Relationship, Immunologic; Female; Histamine Release; Humans; Hypertonic Solutions; Male; Metrizamide; Middle Aged; para-Aminobenzoates; Rats

Metrizamide was employed in six patients who, during angiography, had had severe anaphylactoid reactions to conventional ionic contrast media. Five of these patients had received corticoid premedication before injection of both conventional contrast medium and metrizamide; anaphylaxis occurred only after administration of conventional contrast media. Four patients had no detectable reaction whatsoever after metrizamide; a fifth had only transient tachycardia. In the sixth patient, delayed edema developed in the region of his cerebral arteriovenous malformation. These observations suggest a marked decrease in the incidence and severity of anaphylactoid reactions when metrizamide is substituted in patients who have reacted to ionic contrast media. Metrizamide, or a comparable nonionic contrast agent, should be strongly considered in patients who have had a severe reaction to conventional contrast medium.

Topics: Adolescent; Adult; Aged; Anaphylaxis; Angiography; Child; Contrast Media; Edema; Female; Humans; Male; Metrizamide; Osmolar Concentration; Prednisone; Premedication; Tachycardia

The adverse side effects in a series of 439 myelographies with metrizamide were analyzed. The most frequent side effect was headache, which could be differentiated as early onset headache, related to hydrodynamic modifications in the spinal fluid following lumbar puncture, and late onset headache related to a metrizamide effect. The frequency of late onset headache was at least 27%, but all together 46% of the patients had postmyelographic headache. Meningeal irritation was seen in 5%, sometimes in a severe form, mimicking a septic complication. Spinal irritation and epileptic fits were rarely seen. Striking was the occurrence of an acute psycho-organic syndrome, frequently observed after cervical myelography which was performed with a higher than usual dose of iodine. We can not confirm the general opinion that the central nervous system had a good tolerance for metrizamide.

Topics: Anaphylaxis; Emotions; Epilepsy; Headache; Humans; Metrizamide; Myelography; Neck; Pain; Perception; Spinal Cord Diseases