metrizamide and Meningitis--Aseptic

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

Although metrizamide has been used as a contrast agent for myelography for the past decade, there are few reports of its use in the pediatric population. Aseptic meningitis has rarely been reported as an adverse effect of metrizamide in adults. The first pediatric case of aseptic meningitis following lumbar myelography with metrizamide is reported.

Topics: Female; Humans; Infant; Leg Length Inequality; Meningitis; Meningitis, Aseptic; Metrizamide; Myelography

A clinical constellation of exacerbation of systemic lupus erythematosus (SLE), together with aseptic meningitis, and acute mental symptoms occurred following lumbar myelography with metrizamide. Exacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new.

Topics: Delirium; Humans; Lupus Erythematosus, Systemic; Male; Meningitis; Meningitis, Aseptic; Metrizamide; Middle Aged; Myelography

The effect of iopamidol on the leptomeninges was tested and compared with that of metrizamide and normal saline solution in 18 dogs. Pathologic and clinical effects were evaluated at 24 hours and 14 days after cisternal injection of iopamidol, metrizamide, or normal saline solution. Pathologic changes were evaluated by microscopic examination of serial CSF samples and of sections of brain and spinal cord with the leptomeninges intact. Clinical changes were subjectively evaluated. Electromyograms and EEG were performed on each dog after physical and neurologic examination. There were no changes seen in neurologic status, electromyogram, or EEG in any of the dogs immediately after subarachnoid injection nor at 24 hours or 14 days later. Pathologic changes were limited to mild, moderate, or severe patchy hemorrhagic leptomeningitis seen at 24 hours after iopamidol or metrizamide was injected. The severity of changes were judged to be similar with both these agents. The CSF analysis and histologic evaluation of brain and spinal cord sections revealed a neutrophilic response to iopamidol and a mononuclear response to metrizamide. These findings indicate that iopamidol has minimal neurotoxicologic effect on the leptomeninges and therefore has merit as a myelographic agent.

Topics: Animals; Arachnoid; Contrast Media; Dog Diseases; Dogs; Female; Iopamidol; Iothalamic Acid; Male; Meningitis, Aseptic; Metrizamide; Pia Mater; Subarachnoid Hemorrhage

A clinical constellation of aseptic meningitis, arachnoiditis, communicating hydrocephalus, and a Guillain-Barré syndrome occurred following lumbar myelography with metrizamide. To our knowledge, Guillain-Barré syndrome has not been previously described following myelography with any contrast agent. Meningeal reactions and hydrocephalus have been reported with other agents, but this is the first instance with metrizamide.

Topics: Aged; Arachnoiditis; Humans; Hydrocephalus; Intervertebral Disc Displacement; Male; Meningitis; Meningitis, Aseptic; Metrizamide; Myelography; Polyradiculoneuropathy; Tomography, X-Ray Computed