metrizamide and Epilepsy

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

A parallel, double-blind, randomized study comparing iohexol and metrizamide--both 180 mg l/ml--in lumbar myelography was carried out in 60 consecutive patients. Eight to 15 ml of contrast medium were administered with the upper level at the middle thoracic column. A detailed neurologic examination was performed before and 24 hr after myelography. EEG recordings--evaluated visually and with fast Fourier transformation analysis--and somatosensory evoked responses were registered before, 6 hr after, and 24 hr after myelography. All patients were observed for adverse reactions for 24-48 hr. Iohexol did not produce any epileptiform activity but epileptiform activity was detected in five patients receiving metrizamide. Iohexol produced significantly less frequent and less severe EEG changes than did metrizamide both at visual evaluation (p less than .0025) and at fast Fourier transformation analysis (p less than .04). No significant changes occurred in the early components of the somatosensory evoked potentials after either contrast medium. Iohexol caused significantly (p less than .002) less frequent and less severe adverse reactions than did metrizamide. The neurologic examination revealed no changes of clinical importance with either contrast agent.

Topics: Double-Blind Method; Electroencephalography; Epilepsy; Evoked Potentials, Somatosensory; Female; Humans; Iohexol; Male; Metrizamide; Middle Aged; Myelography; Neurologic Examination; Random Allocation; Risk Factors

Amipaque 280 mg I/ml was compared to Isopaque Cerebral 280 mg I/ml for common carotid injection in twenty patients in a double blind trial. Simple comparison was also performed in examinations with selective external carotid injections. The reaction of the patients to the common carotid injection was mild on the whole but Amipaque caused significantly less discomfort than Isopaque. Selective external carotid injection of Amipaque caused very little discomfort while most patients complained of severe pain when Isopaque was used. No serious side-effect was observed.

Topics: Adult; Aged; Brain Neoplasms; Carotid Arteries; Cerebral Angiography; Cerebrovascular Disorders; Epilepsy; Female; Humans; Iodobenzoates; Male; Metrizamide; Metrizoic Acid; Middle Aged

Glucose, the primary substrate for ATP synthesis, is catabolized during glycolysis to generate ATP and precursors for the synthesis of other vital biomolecules. Opportunistic viruses and cancer cells often hijack this metabolic machinery to obtain energy and components needed for their replication and proliferation. One way to halt such energy-dependent processes is by interfering with the glycolytic pathway. 2-Deoxy-d-glucose (2-DG) is a synthetic glucose analogue that can inhibit key enzymes in the glycolytic pathway. The efficacy of 2-DG has been reported across an array of diseases and disorders, thereby demonstrating its broad therapeutic potential. Recent approval of 2-DG in India as a therapeutic approach for the management of the COVID-19 pandemic has brought renewed attention to this molecule. The purpose of this perspective is to present updated therapeutic avenues as well as a variety of chemical synthetic strategies for this medically useful sugar derivative, 2-DG.

Topics: Adenosine Triphosphate; Antiviral Agents; COVID-19; COVID-19 Drug Treatment; Deoxyglucose; Epilepsy; Glycolysis; Humans; Isotope Labeling; Mitochondria; Neoplasms; Positron-Emission Tomography; SARS-CoV-2; Structure-Activity Relationship; Virus Replication

The case is presented of a patient showing multiple subcortical haemorrhages after lumbar metrizamide myelography. This complication after intrathecally administered metrizamide contrast medium appears not to have been reported before. Several different possible explanations are proposed for the phenomena observed in this case.

Topics: Back Pain; Cerebral Hemorrhage; Electroencephalography; Epilepsy; Hemiplegia; Humans; Lumbosacral Region; Male; Metrizamide; Middle Aged; Myelography; Tomography, X-Ray Computed

The non-ionic X-ray contrast media metrizamide, iopamidol, iohexol, and iopromide do not bind calcium and are less hyperosmolar than the conventional ionic contrast media, for instance amidotrizoate (diatrizoate), iothalamate, or ioglicate. Hence the use of non-ionic contrast media is associated with less undesirable side-effects that are attributable to hypertonicity such as an increase in circulating plasma volume, decreased deformability of red blood cells, damage of vascular endothelium with consequent activation of blood coagulation, the complement system and fibrinolysis, increased release of bradykinin and histamine, cardiac arrhythmias, diuresis, vasodilation and decreased blood pressure, pain and heat sensation. Because of less dilution the quality of imaging is also better. According to the intravenous LD50 in experimental animals the acute toxicity of non-ionic contrast media is lower than that of ionic media. With respect to contrast quality and the rate of side-effects the various non-ionic contrast media appear to be equivalent. Despite their higher price and higher viscosity it is probable that the non-ionic contrast media will replace the classical ionic media, especially in angio- and myelography.

Topics: Animals; Calcium; Contrast Media; Epilepsy; Humans; Iohexol; Iopamidol; Iothalamic Acid; Membrane Potentials; Metabolic Clearance Rate; Metrizamide; Neurons; Structure-Activity Relationship; Triiodobenzoic Acids; Viscosity

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

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

Topics: Adult; Epilepsy; Female; Humans; Lumbosacral Region; Metrizamide; Myelography

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

Topics: Animals; Cerebral Cortex; Contrast Media; Diatrizoate; Electroencephalography; Epilepsy; Female; Iothalamate Meglumine; Male; Mesylates; Metrizamide; Metrizoic Acid; Rabbits; Solubility; Triiodobenzoic Acids; Water

Topics: Animals; Cerebral Cortex; Cisterna Magna; Contrast Media; Dogs; Electroencephalography; Epilepsy; Female; Injections; Iodobenzoates; Iothalamate Meglumine; Iothalamic Acid; Male; Metrizamide; Nervous System; Neuroleptanalgesia; Subarachnoid Space

Topics: Animals; Blood-Brain Barrier; Capillaries; Central Nervous System; Contrast Media; Drug Tolerance; Epilepsy; Guinea Pigs; Iodobenzoates; Metrizamide; Salts