metrizamide and Brain-Diseases

The sensitivity of magnetic resonance imaging (MRI) to tissue alterations is particularly useful in spinal cord imaging. In addition to excellent anatomic display of this compact and complex area, syrinx cavities, tumors, and degenerating disks can be identified before they cause the anatomic distortion often necessary for detection by conventional means.

Topics: Astrocytoma; Bone Marrow Diseases; Brain Diseases; Ependymoma; Humans; Intervertebral Disc Displacement; Lipoma; Magnetic Resonance Spectroscopy; Meningeal Neoplasms; Metrizamide; Myelography; Neurofibroma; Spinal Cord; Spinal Cord Diseases; Spinal Cord Neoplasms; Spinal Diseases; Spinal Injuries; Spine; Syringomyelia; Tomography, X-Ray Computed

The most important complications of intravascular administration of contrast agents include idiosyncratic (anaphylactoid) reactions, shock, congestive heart failure, cardiac arrhythmias, acute renal failure, and neurotoxic effects. The incidence of serious neurotoxic effects is low. Entry of contrast agents into the central nervous system normally is limited but may be increased by osmotic opening of the blood-brain barrier with cerebral arteriography or arch aortography. Most neurotoxic effects are thought to represent direct effects of the contrast agent on brain or spinal cord. Adverse effects with arteriography include seizures, transient cortical blindness, brain edema, and spinal cord injury. Most cases of focal brain deficit (other than cortical blindness) are attributed to embolism secondary to the catheter. Seizures may occur with intravenous administration, especially in patients with brain tumors or other processes disrupting the blood-brain barrier. The most important adverse effects observed with myelographic agents include acute and chronic meningeal reactions with iophendylate, and seizures and transient encephalopathy with metrizamide.

Topics: Animals; Blindness; Blood-Brain Barrier; Brain Diseases; Brain Edema; Central Nervous System Diseases; Cerebrovascular Disorders; Contrast Media; Diatrizoate; Dose-Response Relationship, Drug; Epilepsy; Humans; Injections, Intravenous; Injections, Spinal; Iophendylate; Metrizamide; Rabbits; Spinal Cord Diseases; Visual Cortex

Topics: Brain Diseases; Brain Neoplasms; Cerebral Hemorrhage; Contrast Media; False Positive Reactions; Humans; Intracranial Arteriovenous Malformations; Ischemic Attack, Transient; Meningeal Neoplasms; Meningioma; Metrizamide; Tomography, X-Ray Computed

EEG recordings were obtained before and after intrathecal metrizamide injection in 50 consecutive patients who underwent metrizamide myelography or cisternography. EEG tracings were recorded daily until the pattern returned to baseline. One patient (2%) developed seizures. The most frequent EEG abnormality was generalized slowing of various degrees. In 15 patients (30%), the EEG record was normal throughout the study. In 4 patients (8%), EEG disturbances were seen up to the fifth day after the procedure. Patients who had undergone cervical myelography and cisternography had a marginally higher frequency of EEG disturbances than patients who underwent lumbar myelography. The causes inducing these time-related disturbances are discussed, as compared to pharmacokinetics of intrathecally administered metrizamide.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brain Diseases; Electroencephalography; Female; Humans; Injections, Spinal; Male; Metrizamide; Middle Aged; Myelography; Time Factors

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

Infratentorial epidermoids are rarely seen in the lifetime of a neurosurgeon. Most published series consist of a dozen or so cases. In a period of 20 years we operated on only 6 such patients. Five are doing excellently, one patient died two and a half months after operation of a fulminating infection. The follow-up is of 20 years, 9 years, and 3 years of the first three patients, while the remaining three were operated during the last year. Such an accelerated pace of epidermoid incidence in our department during the last year may be fortuitous, but may also be an indication that, many patients with vague complaints who had an epidermoid, had been missed in the past. Undoubtedly, the CT scan has greatly facilitated the diagnosis of epidermoid cysts, whether infra- or supratentorial. Diagnosis, however, hinges on suspicion or awareness on clinical grounds of the possibility of an infratentorial epidermoid. The analysis of the clinical presentation in our 6 cases, seems to allow the division of infratentorial epidermoids into those that are posteriorly located, which uniformly manifested at some stage of illness raised intracranial pressure, and the anterior epidermoids in the cerebello-pontine angle characterized by the insidious involvement of cranial nerves. Computerized tomography, in some cases with the adjunct of Metrizamide cisternography, confirms the diagnosis and delineates the spread of the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Brain Diseases; Epidermal Cyst; Female; Follow-Up Studies; Humans; Male; Metrizamide; Tomography, X-Ray Computed

Topics: Aged; Brain Diseases; Electroencephalography; Humans; Male; Metrizamide; Myelography; Time Factors

A case of non-neoplastic pineal cyst with Parinaud's syndrome is presented. A 54-year-old woman was admitted to the department of neurosurgery. Fukui Medical School on October, 1985, complaining of the paralysis of upward gaze. A computed tomography (CT) demonstrated a low density mass in the pineal region and the mass was not enhanced after the injection of contrast agent. Metrizamide CT cisternogram delineated the mass clearly. Bilateral carotid and vertebral angiograms showed no significant findings. On November 5, an operation was performed by means of an occipital transtentorial approach. A cyst filled with clear yellowish fluid was found in the pineal region. The cyst was evacuated and its wall was subtotally resected. The histological examination revealed the cystic cavity lined by fibrous astrocytes which were surrounded by normal pineal tissue. Therefore the cyst was diagnosed as a non-neoplastic pineal cyst. The postoperative course was uneventful. The paralysis of upward gaze was gradually improved. On December 27, the patient was discharged in excellent condition. Non-neoplastic small cysts which do not cause an enlargement of the pineal body are common incidental findings at autopsy, whereas large cysts which cause symptoms due to compression of the corpora quadrigemina and the production of internal hydrocephalus are rare. In this paper, non-neoplastic pineal cyst is discussed.

Topics: Brain Diseases; Cysts; Female; Humans; Metrizamide; Middle Aged; Pineal Gland; Tomography, X-Ray Computed

Topics: Brain Diseases; Electroencephalography; Humans; Injections, Spinal; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

A 68-year-old woman with a history of mild hypertension developed a toxic encephalopathy following myelography with metrizamide. Concomitant with the symptoms of vomiting, headache, muscle twitching, and hallucinations was a sudden and marked increase in arterial pressure. Treatment with parenteral vasodilators caused a partial, but transient lowering of the blood pressure. The mental status abnormalities were resolved by treatment with parenteral lorazempam and, subsequently, the blood pressure returned to the premyelography levels. This report demonstrates that metrizamide can induce a severe, accelerated form of hypertension.

Topics: Aged; Brain Diseases; Female; Humans; Hypertension; Metrizamide; Myelography; Time Factors

Epidermoid cysts originating in the paramedian basal cisterns of the posterior fossa are congenital lesions that grow to a large size through slow accumulation of desquamated epithelium. These lesions grow between and ultimately displace cranial nerves, vascular structures, and the brain stem, causing a long course of progressive neurological deficits. The onset of symptoms usually occurs during the fourth decade of life. Epidermoid cysts are easily diagnosed with computerized tomography scans, which characteristically show a low-density extra-axial pattern. The primary surgical objective is to decompress the mass by evacuating the cyst contents and removing nonadherent portions of the tumor capsule; portions of the capsule adherent to vital structures should be left undisturbed. Aseptic meningitis is the most common cause of postoperative morbidity, and its incidence may be minimized by intraoperative irrigation with steroids followed by systemic therapy with dexamethasone. Symptomatic recurrences that occur many years after surgery should be managed with conservative reoperation.

Topics: Adult; Aged; Brain Diseases; Cranial Fossa, Posterior; Epidermal Cyst; Female; Humans; Male; Meningitis, Aseptic; Methods; Metrizamide; Middle Aged; Postoperative Complications; Rupture, Spontaneous; Tomography, X-Ray Computed

We compared intrathecal metrizamide-enhanced CT (metrizamide-CT) and magnetic resonance imaging (MRI) in the evaluation of 17 patients with clinical suspicion of lesions at the cervicomedullary junction. MRI was superior in imaging the position of the cerebellar tonsils and the size and extent of mass lesions. MRI and metrizamide-CT were equal in detecting syringomyelia. CT with and without IV contrast enhancement was necessary to detect calcium or defects in the blood-brain barrier within neoplasms.

Topics: Adolescent; Adult; Aged; Arnold-Chiari Malformation; Brain Diseases; Brain Neoplasms; Child; Female; Humans; Magnetic Resonance Spectroscopy; Male; Medulla Oblongata; Metrizamide; Middle Aged; Spinal Cord Diseases; Spinal Cord Neoplasms; Syringomyelia; Tomography, X-Ray Computed

A prospective study of EEG changes following metrizamide myelography was made on 34 patients aged 17-79 years. EEGs were recorded just before and 22-26 hours after myelography. Usually 8-10 ml of metrizamide was injected by either lumbar or lateral cervical puncture. The concentration of metrizamide was relatively high. EEGs were abnormal in 15 out of the 20 patients whose baseline EEGs were normal. EEGs deteriorated in 10 of the 14 patients whose control tracings were abnormal. High voltage delta activity and/or a great deal of theta activity were common abnormalities. Three patients showed triphasic waves. No relationships were found between the EEG changes and clinical variables. But central nervous system involvements by metrizamide tended to be accompanied by a severe EEG slowing.

Topics: Adolescent; Adult; Aged; Brain Diseases; Central Nervous System Diseases; Electroencephalography; Female; Headache; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea; Prospective Studies; Vomiting

Between July 1981 and August 1983 the authors studied 21 patients with intracranial arachnoid cysts using metrizamide-enhanced CT. With this method we are able to determine the degree of communication between the cysts and the surrounding subarachnoid space as well as to assess the evolving character of some of these lesions. This information will allow a more rational choice of surgical treatment.

Topics: Adolescent; Adult; Aged; Arachnoid; Brain Diseases; Child; Cysts; Female; Follow-Up Studies; Humans; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

We report two patients in whom brain penetrance of grey matter by metrizamide, introduced for myelography thirty hours earlier, mimics the periventricular lucency of white matter disease on cranial computed tomography.

Topics: Aged; Brain; Brain Diseases; Diagnostic Errors; Humans; Male; Metrizamide; Middle Aged; Myelography; Time Factors; Tomography, X-Ray Computed

A 7-year-old boy was admitted because of convulsive seizures. He was diagnosed as agenesis of corpus callosum associated with interhemispheric cyst by CT scan and angiography. Metrizamide CT cisternography and cystography disclosed no communication between interhemispheric cyst and the third ventricle. By means of metrizamide CT cisternography and cystography, the authors considered this interhemispheric cyst gradually increased by some kinds of ball-valve mechanism. Cysto-peritoneal shunt was carried out. Postoperative course was uneventful and follow-up CT revealed disappearance of interhemispheric cyst and typical findings of the acallosal brain. Improvement of clinical symptoms and EEG findings occurred after operation. Agenesis of the corpus callosum associated with interhemispheric cyst is rare. The authors can find only one case of this brain anomaly in the literature in which there is no communication between interhemispheric cyst and the third ventricle. Metrizamide CT cisternography and cystography was very useful in diagnosis and selection of treatment.

Topics: Brain Diseases; Cerebral Angiography; Cerebrospinal Fluid Shunts; Child; Corpus Striatum; Cysts; Humans; Male; Metrizamide; Peritoneal Cavity; Tomography, X-Ray Computed

The characteristic findings of metrizamide CT cisternography in two cases of epidermoid are reported. The main finding was a "cauliflower-like" appearance and was thought to be caused by the irregular interstices of epidermoids. Metrizamide CT cisternography may be helpful in making a diagnosis of an epidermoid.

Topics: Adolescent; Adult; Brain Diseases; Cerebral Ventricles; Epidermal Cyst; Female; Humans; Male; Metrizamide; Sella Turcica; Tomography, X-Ray Computed

Topics: Adolescent; Brain Diseases; Child; Child, Preschool; Humans; Male; Metrizamide; Myelography; Tomography, X-Ray Computed

Metrizamide, a major contrast agent for myelographic procedures, has rarely been reported to cause irreversible neurologic complications. The major transient neurologic alterations include neuropsychological reactions, generalized tonic-clonic seizures, and headaches. Two cases of irreversible spinal neurologic deficits resulting from metrizamide myelography are reported, and the factors that may increase the risks of complications in metrizamide myelographic studies are discussed, including preexisting dehydration, patient positioning, and the concentration of contrast agent.

Topics: Adult; Brain Diseases; Headache; Humans; Male; Metrizamide; Middle Aged; Myelography; Nervous System Diseases; Seizures; Vomiting

Computerized frequency analysis was used to quantitate the EEG effects of intrathecal metrizamide in 22 patients undergoing radiographic procedures. In comparison to baseline recordings, no changes were found immediately after the procedure, but a significant (p less than 0.001) shift to lower frequencies was seen at 16 to 26 hours. Individually significant changes were infrequent with lumbar myelograms or low-dose cisternograms and were most prominent in patients who had the combination of high metrizamide dose, cervical level, and a complex procedure with prolonged supine positioning.

Topics: Brain Diseases; Electroencephalography; Humans; Metrizamide; Myelography

Metrizamide (Amipaque), a water soluble nonionic contrast medium has less toxic effect in comparison with other contrast media, and it is now widely used for myelography, cisternography, ventriculography and cerebrospinal fluid dynamic imaging. However, as the number of cases in which this medium has been utilized has gradually increased, incidents of toxic manifestations have been reported. Among these, there are a considerable number of case reports referring to metrizamide encephalopathy, but only a few authors reported the appearance of triphasic waves on EEG when they occurred. The authors experienced one case of metrizamide encephalopathy accompanied by frequent appearance of triphasic waves on EEG. A 31-year old male was admitted to our hospital with the complaint of right homonymous hemianopsia. At that time he was fully conscious and mentally alert. On CT, 39 mm X 45 mm partially enhanced isodense mass was revealed on the enlarged sella turcica. Laboratory findings showed high titer of prolactin (10200 ng/ml). Premedication of 100 mg phenobarbital i.m. was followed by the tomography of the sella turcica, using 8 ml of 250 mgI/ml metrizamide injected into L 3-L 4 subarachnoid space. Several hours after the examination, he complained of slight nausea and was kept in bed with his head placed in an elevated position. The next morning, he was found to be in a drowsy state. He was disoriented and could not respond adequately to questions asked. His naming of daily necessities was also poor, although he knew how to use them.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Brain; Brain Diseases; Electroencephalography; Hemianopsia; Humans; Injections, Spinal; Male; Metrizamide; Tomography, X-Ray Computed

Topics: Aged; Brain Diseases; Electroencephalography; Female; Humans; Metrizamide

The authors describe three cases of intracranial epidermoid cysts specifically diagnosed by metrizamide CT cisternography. In CT cisternography of epidermoid cysts, metrizamide enters deep in the tumor clefts and depicts the lobulated margin of the tumor. We consider these findings are specific for this tumor and similar to the findings reported previously in pneumoencephalography or positive contrast cisternography.

Topics: Brain Diseases; Epidermal Cyst; Female; Humans; Metrizamide; Middle Aged; Pneumoencephalography; Tomography, X-Ray Computed

Topics: Adult; Brain Diseases; Dexamethasone; Humans; Male; Metrizamide; Myelography; Substance-Related Disorders

Topics: Adult; Brain Diseases; Cerebral Ventricles; Cerebral Ventriculography; Cysticercosis; Female; Humans; Hydrocephalus; Male; Metrizamide; Pneumoencephalography; Rupture; Tomography, X-Ray Computed

The practical usefulness of computed tomography with intrathecal metrizamide in imaging the brain stem is illustrated in six examples where the lesions were misdiagnosed on intravenously enhanced computed tomography, angiography, or air study. Focal and diffuse atrophic changes of the brain stem were demonstrated in symptomatic patients where none of the other radiographic or clinical investigations were conclusive. Metrizamide computed tomography is probably the most sensitive method for imaging lesions in and around the brain stem and cerebellopontine angle.

Topics: Adolescent; Adult; Atrophy; Brain Diseases; Brain Neoplasms; Brain Stem; Female; Humans; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Topics: Brain Diseases; Confusion; Electroencephalography; Humans; Male; Metrizamide; Middle Aged; Myelography; Spinal Diseases

Previous experimental studies caution against the use of neurolept anaesthesia during subarachnoid injection of metrizamide for neuroradiodiagnostic procedures because of severe epileptogenic complications. To examine whether these recommendations are relevant in the clinical situation or not, 104 patients were studied. They underwent neuroradiological investigations with metrizamide subarachnoidally and were anaesthetized with neurolept anaesthesia either during the investigation (59 patients, Group I) or within 48 h afterwards (45 patients, Group II) when a neurosurgical operation was performed. In 10 patients of Group I, EEG was recorded during the investigation. All patients were observed for occurrence of clinical epileptic manifestations during and after the anaesthesia. Apart from one patient who had a short episode of suspected epileptogenic EEG-activity shortly after the injection of metrizamide, none of the other patients showed EEG-abnormalities of epileptogenic type and none of them had any clinical signs of epileptic manifestations. On the basis of the results of this clinical study it is concluded that neurolept anaesthesia does not increase the risk of epileptic complications during neuroradiological investigations with metrizamide.

Topics: Adolescent; Adult; Aged; Brain Diseases; Child; Child, Preschool; Electroencephalography; Epilepsy; Female; Fentanyl; Humans; Infant; Male; Metrizamide; Middle Aged; Neuroleptanalgesia; Phenoperidine; Radiography; Time Factors

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventricles; Child; Cysticercosis; Humans; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Topics: Brain Diseases; Cervical Vertebrae; Electroencephalography; Female; Humans; Metrizamide; Middle Aged; Radiography

This report describes two cases of epidermoid tumor of the fourth ventricle diagnosed with metrizamide computed tomography. They both presented as a low-density lesion in the region of the fourth ventricle on computed tomography. They did not show any enhancement after intravenous injection of contrast medium and had no hydrocephalus. Metrizamide-enhanced computed tomography demonstrated the irregular fourth-ventricular filling defect characteristic of epidermoid tumors.

Topics: Adult; Brain Diseases; Cerebral Ventricles; Cerebral Ventriculography; Cholesteatoma; Humans; Injections, Spinal; Male; Metrizamide; Radiographic Image Enhancement; Tomography, X-Ray Computed

A patient with sudden apoplexy and coma was found to have hydrocephalus on computed tomographic scan, and metrizamide was instilled into the ventricles. Subsequent autopsy disclosed a brainstem infarct secondary to a primary dissecting aneurysm of the basilar artery, and a histologic picture of encephalitis in the walls of the lateral and third ventricles. Metrizamide may cause pathologic changes that must be recognized for the correct interpretation by the pathologist of tissue sections previously exposed to metrizamide. In the present case, the changes were seen 11 days after exposure of the tissue to metrizamide, consonant with the time course of similar changes observed in animals. The localization of the cellular infiltrates to the Virchow-Robin spaces corroborates evidence from the literature that metrizamide enters brain parenchyma via these spaces.

Topics: Adult; Arachnoiditis; Brain Diseases; Female; Humans; Injections, Intraventricular; Metrizamide

Thirty-one cases of arachnoid cysts of the middle cranial fossa were investigated by CT scan, 7 of them undergoing additional metrizamide CT cisternography. In this paper we analyze and correlate the different findings from these two examinations and propose a classification of arachnoid cysts of the middle cranial fossa into three basic types. Pathophysiological and surgical implications are discussed.

Topics: Adolescent; Adult; Arachnoid; Brain Diseases; Child; Cysts; Female; Humans; Intracranial Pressure; Male; Metrizamide; Middle Aged; Myelography; Prognosis; Tomography, X-Ray Computed

Topics: Arnold-Chiari Malformation; Atrophy; Brain Diseases; Brain Neoplasms; Cerebellar Diseases; Cerebellum; Cerebrovascular Circulation; Cranial Fossa, Posterior; Cysts; Female; Hematoma; Humans; Image Enhancement; Infant, Newborn; Infections; Metrizamide; Skull; Tomography, X-Ray Computed; Vascular Diseases

Topics: Brain; Brain Diseases; Diagnosis, Differential; Humans; Metrizamide; Myelography; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventriculography; Child; Convulsants; Electroencephalography; Female; Humans; Iothalamic Acid; Male; Meglumine; Metrizamide; Middle Aged; Myelography; Seizures; Sorbitol

Topics: Brain Diseases; Cerebral Ventricles; Cerebral Ventriculography; Child, Preschool; Diagnosis, Differential; Humans; Hydrocephalus; Infant; Male; Metrizamide; Nerve Compression Syndromes; Tomography, X-Ray Computed

Topics: Adult; Brain Diseases; Humans; Male; Metrizamide; Myelography; Tomography, X-Ray Computed

In children, hypothalamic-hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography.

Topics: Adenoma; Adolescent; Astrocytoma; Brain Diseases; Brain Neoplasms; Child; Dysgerminoma; Empty Sella Syndrome; Female; Hamartoma; Humans; Hypothalamo-Hypophyseal System; Infant; Male; Metrizamide; Pituitary Neoplasms; Tomography, X-Ray Computed; Tuber Cinereum

A case is presented in which cervicolumbar myelography with metrizamide was followed by transient encephalopathy and asterixis. Metabolic etiology was excluded. A large degree of intracranial penetration of metrizamide was demonstrated by computerized tomography. Residual symptoms persisted for 10 days.

Topics: Brain Diseases; Female; Humans; Metrizamide; Middle Aged; Muscular Diseases; Myelography; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Brain Diseases; Child; Child, Preschool; Cisterna Magna; Female; Humans; Infant; Male; Metrizamide; Middle Aged; Tomography, X-Ray

Computed tomographic cisternography (CTC) shows small normal and pathological structures in the extracerebral CSF spaces in an excellent way and is able to differentiate communicating from non-communicating CSF-containing cysts in congenital malformations and acquired lesions. The main value of the CTC is in the examination of CSF dynamics. A report is given about our experiences with 121 patients. The dynamic flow patterns are divided into eight groups. The results are discussed in detail with suggestions as to the treatment.

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebrospinal Fluid; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Injections, Spinal; Male; Metrizamide; Middle Aged; Myelography; Radiographic Image Enhancement; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventriculography; Cerebrospinal Fluid; Female; Humans; Infant; Male; Metrizamide; Middle Aged; Radiographic Image Enhancement; Tomography, X-Ray Computed

Although computerized cranial tomography (CT) is useful for the diagnosis of hydrocephalus and various fluid-containing intracranial cysts. CT cannot always define the functional relationship of the cyst to the normal CSF pathways. In such cases, ventriculography may be necessary to determine proper treatment. Metrizamide, a nonionic water-soluble contrast medium, has been used for myelography and ventriculography in adults and for myelography in children. Eleven children have been ventriculograms using metrizamide with conventional roentgenographic techniques. Diagnostic information was obtained in all but one study. No major complications occurred.

Topics: Adult; Brain Diseases; Cerebral Ventriculography; Child; Child, Preschool; Cysts; Humans; Hydrocephalus; Infant; Metrizamide

Topics: Arachnoid; Brain Diseases; Cerebral Ventriculography; Cysts; Female; Humans; Infant; Metrizamide; Tomography, X-Ray Computed

The diagnosis of intracranial cystic lesions is greatly facilitated by cranial computerized tomography (CT) which eliminates the need for further invasive neuroradiological studies. However, cystic lesions with thin walls that do not enhance following intravenous contrast infusion, especially when they are located in the midline and at the base of the skull, may become a diagnostic problem preventing proper management and therapy. We discuss 12 midline intracranial lesions, including one that is noncystic, to emphasize the limitations of CT in showing these lesions and the need for further diagnostic studies such as pneumoencephalography and metrizamide CT. The limitations of CT in diagnosing these lesions are related to the variations in the anatomy at the base of the skull (supra-sellar region); the varying pathological nature and behavior of certain cystic lesions such as epidermoid tumors and craniopharyngiomas; and the compromising of the spatial and density resolutions due to the partial volume effect. The complementary role of studies such as pneumoencephalography and CT metrizamide cisternography for the evaluation of the dynamics of the cerebrospinal fluid that are necessary for the proper management and therapy of patients is discussed.

Topics: Adult; Astrocytoma; Brain Diseases; Brain Neoplasms; Child, Preschool; Craniopharyngioma; Cysts; Diatrizoate Meglumine; Epidermal Cyst; Female; Humans; Male; Metrizamide; Pneumoencephalography; Radiographic Image Enhancement; Subarachnoid Space; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Brain Diseases; Child; Child, Preschool; Female; Humans; Hydrocephalus; Infant; Infant, Newborn; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases; Tomography, X-Ray Computed

Topics: Acute Disease; Brain Diseases; Humans; Male; Metrizamide; Middle Aged; Myelography

Two patients seen after lumbar myelography with metrizamide demonstrated transient confusion and asterixis. Metabolic etiologies were excluded. To our knowledge, these are the first reported cases of asterixis following myelography with metrizamide.

Topics: Brain Diseases; Humans; Male; Metrizamide; Middle Aged; Movement Disorders; Myelography

Cerebrospinal fluid (CSF) circulation has been analyzed by metrizamide computed tomography (CT) cisternography in 46 patients. Included were 7 patients without any clinical evidence of impaired CSF circulation, and 39 with hydrocephalus due to various causes. CT cisternography delineated the anatomical structures of the CSF pathways clearly and accurately and enabled us to analyze ventricular filling in a quantitative manner. As a result, a new, more precise CT cisternographic classification of the CSF flow patterns has been established. On the basis of the presence of ventricular reflux and stasis, extent of ventricular filling, and convexity flow of metrizamide, seven groups of flow patterns have been defined.

Topics: Adult; Aged; Brain; Brain Diseases; Cerebral Aqueduct; Cerebral Hemorrhage; Cerebral Ventriculography; Cerebrospinal Fluid; Child; Child, Preschool; Female; Humans; Hydrocephalus; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Alteration in the cerebrospinal fluid (CSF) circulation was studied in 62 patients with neurosurgical diseases by CT cisternography using a water-soluble contrast medium, metrizamide, and also with radionuclide (169Yb- or 111In-DTPA) cisternography. As a rule, the patterns of both methods were in good agreement. The findings were classified into 3 types and 5 subdivisions. CT cisternography is useful for sequential observation of the CSF circulation with detailed morphological definition, and radionuclide cisternography is useful for observing the general flow of CSF. Some patients with hydrocephalus showed hypodensity around the ventricle, where migration of metrizamide was observed on CT images after its ventricular reflux. This suggests an increased transependymal resorption of CSF. The mathematical analysis of attenuation coefficients on CT cisternography provided more objective and quantitative data for study of CSF dynamics.

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebrospinal Fluid; Child; Child, Preschool; Female; Humans; Image Enhancement; Infant; Male; Metrizamide; Middle Aged; Neurosurgery; Radiographic Image Enhancement; Rheology; Tomography, Emission-Computed; Tomography, X-Ray Computed

Radiographic quality as well as adverse effects of intrathecal metrizamide instillation was prospectively investigated in thirty-three clinical cases admitted to the department of neurosurgery, University of Tokyo Hospital, and Kantoh Teishin Hospital. Metrizamide CT cisternography was performed in fifteen cases using in most cases 10 ml of 170 mg I/ml solution through lumbar route. Eleven cases exhibited "normal" pattern CSF circulation and the remaining four, "delayed" pattern. Eight cases (53%) experienced headache, nausea, and/or vomiting several hours after the instillation. All of these belong to the "normal" pattern group. Four cases of "normal" pattern received electroencephalographic examinations before and after metrizamide instillation. Three revealed appearance of negative spike and slow wave burst or sharp waves one to twenty-four hours after the instillation, along with penetration of metrizamide into brain parenchyma. Diagnostic quality was interpreted as "good" in eleven cases. Small acoustic neurinoma, pituitary adenoma, arachnoid cyst, and subdural hygroma were diagnosed among others. Metrizamide ventriculography was done in four cases. No untoward effect of significance was attributed to metrizamide per se. Cervical myelograpy and/or CT myelography was done in fourteen cases using, in most cases, 10 ml of metrizamide 170 mgI/ml. Polytome tomography with metrizamide instillation through lateral cervical puncture was highly diagnostic, whereas, ordinary X-ray with lumbar instillation yielded less satisfactory results. CT myelography in cases of subarachnoid block required good consideration on instillation site and positioning of the patient. Six cases (50%) among twelve cases where metrizamide had run into the cranial cavity experienced headache, nausea, and/or vomiting to a lesser degree than those of cisterno graphy. Metrizamide is the first contrast agent ever made which can be safely introduced into human subarachnoid space, if administered judiciously, nervous. However, metrizamide is weakly toxic to central system and provokes minor untoward effects as well as electroencephalographic abnormalities and, sometimes, clinical convulsive seizure. It would be wiser to restrict the dosage of metrizamide in cisternographic study, expecially in cases of "normal" pattern CSF circulation, to 1.2 gI or 7 ml of 170 mg I/ml solution. Routine use of X-ray cisternography should thus be discouraged because it needs higher concentration of metrizami

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventriculography; Cranial Nerve Neoplasms; Female; Humans; Injections, Spinal; Male; Metrizamide; Middle Aged; Myelography; Neuroma, Acoustic; Spinal Cord Diseases; Tomography, X-Ray Computed

The results obtained in 145 cases of space-occupying lesions in the sellar and suprasellar structures, after exploration with computer assisted tomography, were used to assess the technical and diagnostic value of this procedure. Precise details of the localization and extent of the lesion can be obtained, but not the nature of the lesion in many cases.

Topics: Brain Diseases; Brain Neoplasms; Humans; Metrizamide; Pneumoencephalography; Sella Turcica; Tomography, X-Ray Computed

A summary is given of the results of vascular studies with metrizamide (Amipaque) in four territories: four-vessel studies in children under 1 year of age, vertebral angiography in adults at risk, spinal angiography and superselective studies in the external carotid territory. A comparison is made with the results obtained with meglumine iothalamate and meglumine ioxithalamate.

Topics: Adolescent; Angiography; Brain Diseases; Carotid Artery, External; Cerebral Angiography; Humans; Infant; Iothalamate Meglumine; Male; Metrizamide; Spinal Cord

Topics: Adult; Aged; Brain; Brain Diseases; Cerebellar Neoplasms; Cranial Fossa, Posterior; Female; Humans; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Topics: Adult; Aged; Brain; Brain Diseases; Cerebrospinal Fluid; Child; Child, Preschool; Female; Humans; Hydrocephalus; Infant; Injections, Intraventricular; Injections, Spinal; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Topics: Brain Diseases; Humans; Metrizamide; Myelography; Tomography, X-Ray Computed

Computer tomography (CT) findings obtained from the first 3,000 scans on 2,031 patients were analyzed and discussions were made on various kinds of neurological diseases, especially from the neurosurgical point of view. CT showed an excellent resolution for three-dimensional morphological pattern of intracranial lesion with a high percentage of diagnostic accuracy as reported from other institutes, resulting in making much earlier morphological diagnosis of intracranial lesion possible than any other examination. Scan methods consisted of plain CT, contrast enhanced CT, and metrizamide CT cisternography. Sequential delayed enhanced CT offered more useful information for high diagnostic accuracy, particularly for nature of brain tumor. Metrizamide CT cisternography was performed for the evaluation of cerebrospinal fluid dynamics and diagnosis of skull base tumors. CT is a new, epoch-making and non-invasive diagnostic approach in neuroradiology and contributes to obtain the better achievement of neurosurgical results.

Topics: Adolescent; Adult; Aged; Brain Diseases; Brain Neoplasms; Cerebrovascular Disorders; Child; Child, Preschool; Contrast Media; Craniocerebral Trauma; Diagnosis, Differential; Female; Head; Humans; Hydrocephalus; Infant; Infant, Newborn; Male; Metrizamide; Middle Aged; Radiographic Image Enhancement; Tomography, X-Ray Computed

The techniques of Amipaque (metrizamide) computerized tomography (CT) cisternography and Amipaque CT ventriculography are described. Normal, intermediate, delayed, and obstructive cerebrospinal fluid circulation patterns are readily demonstrated by evaluation of ventricular stasis of Amipaque on serial CT scans. Both the morphological and physiological characteristics of intracranial cysts are accurately defined and a diagnostic classification is presented. The functional integrity of ventricular shunts can be appraised using the ventricular persistance of Amipaque as a primary criterion. Other applications of these modalities are described and their place in the neurodiagnostic armamentarium is discussed.

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventriculography; Cerebrospinal Fluid; Cerebrospinal Fluid Rhinorrhea; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Cysts; Humans; Hydrocephalus; Infant; Metrizamide; Middle Aged; Tomography, X-Ray Computed

The patient is a 17-year-old female. She was suffering from dwarfism, irregular menstruation and obesity. Out of the dwarfism, there were no other neurological abnormalities. The serious clinical examinations were performed, and the cerebral angiography and the CT scan demonstrated the findings of the obstructive hydrocephalus. Namely, enlarged IIIrd ventricle and small IVth ventricle were observed with routine CT scan. Because these findings on CT scan, we thought the hydrocephalus was based on the aqueductal stenosis. The vertebral angiography showed stretched posterior medial choroidal arteries and compressed the basilar tip posteriorly and inferiorly. Moreover, the carotid-angiography demonstrated the following findings, unrolling of the anterior cerebral arteries laterally stretched bilateral lenticulostriate arteries laterally shifted sylvian groups of the middle cerebral arteries, and stretched bilateral internal cerebral veins. Judging from that angiographic findings and CT scan, we thought there would be cystic tumor in the IIIrd ventricle. However, we suspected the IIIrd ventricular tumor, we were not able to differentiated it from the enlarged IIIrd ventricle itself exactly. Because, it's density in CT scan was equaled with that the cerebrospinal fluid. According to above facts, we performed "Amipaque CT ventriculography through the ventricular catheter after V-P shunt. By "the Ampiqque CT ventriculography" we found exactly there was large cystic tumor in the IIIrd ventricle. Their manifestation and some differential diagnosis were discused.

Topics: Adolescent; Brain Diseases; Cerebral Ventriculography; Cysts; Female; Humans; Metrizamide; Tomography, X-Ray Computed

Topics: Adult; Aged; Brain; Brain Diseases; Child; Female; Humans; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Metrizamide CT cisternograms were performed on 39 patients with a clinical diagnosis of CSF abnormalities; 20 of these patients underwent radionuclide cisternography as well. Comparison of metrizamide CT and RN cisternography revealed good correlation in the degree, extent, and time sequence of ventricular reflux as well as the extent of cortical staining and cisternal filling. Metrizamide cisternography had the advantage of excellent anatomic detail and lower exposure dose, although minor complications were more frequent with this technique. Metrizamide CT cisternography has a potential to become the preferred method of evaluating patients with abnormal CSF dynamics.

Topics: Adolescent; Adult; Aged; Brain; Brain Diseases; Cerebrospinal Fluid; Child; Female; Humans; Hydrocephalus, Normal Pressure; Male; Metrizamide; Middle Aged; Radionuclide Imaging; Subarachnoid Hemorrhage; Tomography, X-Ray Computed

This study describes a new technique for the study of posterior fossa extraaxial cysts. Using metrizamide (Amipaque) CT cisternography, a rapid, simple, low morbidity method is now available which gives both anatomic and physiologic information that may obviate the need for pneumoencephalography and angiography. Two cases are reported; in a third the diagnosis was definitively excluded. By doing serial CT scans following the intrathecal introduction of metrizamide, data concerning the diffusion characteristics of these cysts as well as the accompanying hydrocephalus are obtained.

Topics: Adult; Brain Diseases; Contrast Media; Cysts; Humans; Infant; Injections, Spinal; Iodobenzoates; Male; Metrizamide; Myelography; Tomography, X-Ray Computed

The methodology and clinical use of metrizamide (Amipaque) computed tomography (CT) cisternography are described as applied in the cases of 22 children with morphologic and physiologic abnormalities affecting the cranial portion portion of the central nervous system. In contrast to pneumoencephalography, CT cisternography affords equivalent or superior visualization of the basal cranal subarachnoid spaces with simpler technique and low morbidity. Intrathecal metrizamide enchancement in children causes a very low incidence of side effects.

Topics: Adenoma, Chromophobe; Adolescent; Brain Diseases; Brain Neoplasms; Brain Stem; Child; Child, Preschool; Contrast Media; Cysts; Encephalomalacia; Glioma; Humans; Hydrocephalus; Infant; Injections, Spinal; Iodobenzoates; Metrizamide; Myelography; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebellar Neoplasms; Child; Child, Preschool; Cranial Fossa, Posterior; Female; Humans; Iodobenzoates; Male; Metrizamide; Middle Aged; Radiography