metrizamide and Basal-Ganglia-Diseases

A case of postoperative haemorrhage into the basal ganglia following decompression of the craniovertebral junction in a 35-year-old patient is presented. Similar cases in the literature of intracerebral bleeding remote from the site of surgery are reviewed and the possible pathogenesis of this unusual complication discussed.

Topics: Adult; Basal Ganglia Diseases; Cerebellar Diseases; Cerebral Hemorrhage; Cervical Vertebrae; Humans; Male; Metrizamide; Myelography; Postoperative Complications; Prolapse; Skull; Tomography, X-Ray Computed

This report describes a case of metrizamide encephalopathy with persistent disturbance of consciousness and extrapyramidal symptoms. These two conditions have rarely been reported among the various adverse effects of metrizamide. An 11-year-old girl had been in almost good health until she was ten years old, at which time she received a ventriculo-peritoneal shunt operation, suffering from hydrocephalus of unknown etiology. At the age of eleven, she was admitted to our hospital due to hydrocephalus recurrence. She was examined by metrizamide shunt-gram (1200 mg iodide/4 ml). On the next day, she became drowsy. The CT scan disclosed the periventricular penetration of metrizamide into the medial part of the thalamus and the caudate nucleus. Thirteen days later, disturbance of consciousness continued, and extrapyramidal symptoms, that is, rigo-spasticity and postural tremor, were observed. Oral administration of L-threo-DOPS, the direct precursor of noradrenaline, was effective against the persistent disturbance of consciousness and L-DOPA was effective against the extrapyramidal symptoms. She soon recovered almost to normal and no neurological deficit remained. We thus conclude that the CT scan findings and effects of L-threo-DOPS and L-DOPA suggest that metrizamide encephalopathy in this case were respectively due to its periventricular penetration into the medial part of the thalamus and the caudate nucleus, and the resultant deficiency of the ascending noradrenergic reticular activating system and the nigrostriatal dopaminergic system.

Topics: Basal Ganglia Diseases; Brain; Brain Diseases; Child; Cognition Disorders; Consciousness Disorders; Droxidopa; Electroencephalography; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Hydrocephalus; Levodopa; Metrizamide; Serine; Tomography, X-Ray Computed