metrizamide and Cognition-Disorders

Based upon the results of repeated psychologic tests, psychic impairment following myelography has been studied in 60 patients. Thirty of these had lumbar myelography with metrizamide and 30 with iohexol. Psychic impairment was noted in both groups, although with a higher frequency and much more marked in the group which had metrizamide myelography. For this type of examination iohexol is thus to be recommended.

Topics: Cognition Disorders; Contrast Media; Double-Blind Method; Drug Evaluation; Female; Humans; Intervertebral Disc Displacement; Iodobenzoates; Iohexol; Male; Metrizamide; Middle Aged; Myelography; Psychological Tests; Random Allocation; Spinal Stenosis; Time Factors; Triiodobenzoic Acids

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

A battery of brief cognitive tests and a mood scale were administered to 42 patients before and after cervical myelography with either metrizamide (20 patients) or iohexol (22 patients). The patients receiving metrizamide experienced a deterioration in mood after myelography and a relatively greater decline in cognitive test performance than did those receiving iohexol. These two side effects tended to occur together in the metrizamide group, suggesting a common underlying cause; but there was no correlation between changes in mood and cognitive function after myelography with iohexol. These results suggest that metrizamide has a greater neurotoxic effect than iohexol.

Topics: Adult; Cognition Disorders; Female; Humans; Iodobenzoates; Iohexol; Male; Metrizamide; Middle Aged; Mood Disorders; Myelography; Psychological Tests; Triiodobenzoic Acids

A case of absence status epilepticus resulted from metrizamide myelography. The acute confusional state following metrizamide myelography is briefly reviewed and compared with the confusional state resulting from adult-onset absence status. The similarities suggest that absence status may in fact be a relatively common cause of prolonged confusion following the use of metrizamide. Given the difficulty in clinical diagnosis and the excellent response to anticonvulsants, the possibility of absence status should be specifically excluded by EEG in any person suffering prolonged confusion following metrizamide myelography.

Topics: Aged; Cognition Disorders; Confusion; Female; Humans; Metrizamide; Myelography; Status Epilepticus

Groups each consisting of ten patients underwent lumbar and cervical myelography with metrizamide and iopamidol, together with a control group of ten patients who underwent lumbar punctures only. These groups were studied with a psychopathometric test procedure in order to demonstrate and quantify mental disturbances. It was shown that in contrast to myelography with iopamidol, mild mental disturbances are common after myelography with metrizamide. The severity of the mental disturbances after myelography with metrizamide was dependent on the quantity of contrast medium which diffused into the intracranial space after myelography, suggesting a dose-related neurotoxic effect of this substance. Such a correlation was not found with iopamidol.

Topics: Adolescent; Adult; Aged; Cognition Disorders; Contrast Media; Female; Humans; Iopamidol; Iothalamic Acid; Male; Metrizamide; Middle Aged; Myelography; Psychological Tests; Time Factors

One hundred patients were questioned after metrizamide myelography about the side effects of the examination. The number and type of side effects were tabulated and correlated with investigated region (e.g., cervical, lumbar) and with use of medication (e.g., analgesics, diuretics). The number of side effects, particularly neuropsychologic, were higher than previously reported. The most common side effects were minor meningeal irritations (headache, nausea, dizziness, and vomiting) and were regarded by the patients as inconsequential. All side effects became apparent during the first 24 hr after myelography and all were transitory. The side effects, being minor, should not limit the use of metrizamide for myelography. However, those caring for patients who have undergone the study should be aware of the possible side effects.

Topics: Adult; Affective Symptoms; Aged; Aphasia; Cognition Disorders; Dizziness; Dysarthria; Female; Hearing; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea; Pain; Sleep Wake Disorders; Time Factors; Vision, Ocular; Vomiting

The importance of accurate diagnosis of epileptic manifestations, even if unusual, as complications of diagnostic metrizamide exploration of the CSF space is emphasized on the basis of 2 case histories.

Topics: Adult; Cognition Disorders; Confusion; Electroencephalography; Epilepsies, Myoclonic; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Speech Disorders; Syndrome

A patient exhibited confusion, dysphasia, and striking asterixis 18 hours after metrizamide myelography. The symptoms lasted for a day and a half. While metrizamide is a useful contrast medium, side effects are not unusual and can, on occasion, be quite severe.

Topics: Adult; Aphasia; Cognition Disorders; Confusion; Electroencephalography; Humans; Metrizamide; Movement Disorders; Myelography

Topics: Adult; Aged; Aphasia; Cognition Disorders; Contrast Media; Female; Humans; Male; Metrizamide; Middle Aged; Movement Disorders; Myelography; Nervous System Diseases; Seizures

A case of alarming, but transient clinical and EEG disturbances following cervical myelography with metrizamide (Amipaque) is reported. Clinically, mental disturbances and epileptic seizures were prominent, while bilateral rhythmic slow waves and spikes occurred in the EEG recordings.

Topics: Cognition Disorders; Confusion; Epilepsy; Humans; Male; Metrizamide; Middle Aged; Myelography