metrizamide and Paraplegia

Topics: Adult; Arteriovenous Malformations; Female; Humans; Metrizamide; Myelography; Paraplegia; Spine

Intractable lower extremity spasms after spinal cord injury is a significant source of morbidity. A case of refractory spasticity in paraplegia was successfully converted to flaccid paraplegia by intrathecal injection of phenol and glycerin in metrizamide. This chemical rhizolysis is simple and effective, and the presence of metrizamide allows both fluoroscopic guidance for accurate intrathecal phenol placement and good miscibility with cerebrospinal fluid. A brief comparative review of alternative therapeutic modalities is presented.

Topics: Adult; Glycerol; Humans; Leg; Male; Metrizamide; Paraplegia; Phenol; Phenols; Spasm

A patient suffered from paraplegia of T-10 level at age 29, and he complained of new symptoms in the upper limbs at age 42. Gradual ascending worsening occurred, and the diagnosis of post-traumatic syringomyelobulbia was made 23 years after the initial accident. CT scan with metrizamide transit at the medulla level confirmed the diagnosis. Definite clinical improvement was seen after syringo-peritoneal shunting. Clinical, radiological and therapeutic aspects are briefly discussed.

Topics: Adult; Drainage; Humans; Male; Medulla Oblongata; Metrizamide; Middle Aged; Paraplegia; Peritoneal Cavity; Spinal Cord; Spinal Cord Injuries; Syringomyelia; Time Factors; Tomography, X-Ray Computed

Epileptic seizures are a known complication of metrizamide myelography. To our knowledge, this is the first report of a case of nonconvulsive status epilepticus of the absence type following metrizamide myelography. There was symptomatic and electroencephalographic improvement after intravenous administration of antiepileptic drugs, and there was no neurological residual. Nonconvulsive status epilepticus should be considered when impairment of consciousness supervenes after radiographic procedures using metrizamide.

Topics: Electroencephalography; Epilepsy, Absence; Humans; Male; Metrizamide; Middle Aged; Muscle Spasticity; Myelography; Paraplegia; Spinal Osteophytosis; Status Epilepticus

A case of posttraumatic syringomyelia which appeared 26 years after the injury was presented. A patient was 61 year old female, who sustained thoraco-lumbar spine injuries rendering her to paraplegic in 1954. Eleven months later she had an operation of T6-T9 and L1-L2 laminectomies and regained motor and sensory functions of the both lower extremities. She was ambulatory with crutches till 1979. In 1980, burning pain was noticed in the left scapular region, and thereafter, extended to the ulnar side of the left forearm. The pain became progressively worse and intractable. Analgesics were ineffective. Two years later muscle atrophies and weakness in the left finger intrinsic muscles appeared. Absent deep tendon reflexes in the left upper extremity, dissociated sensory loss (in the left C2-S1 and right T5-T12 dermatomes) and paraparesis were also documented. Metrizamide CT scan performed 24 hours after the intrathecal injection disclosed an intramedullary syrinx between C2 and L1 vertebral levels. No communication with the fourth ventricle was seen. A syringoperitoneal shunt with low pressure valve was placed. The pain subsided immediately after this procedure. However, no improvement in motor and sensory functions were observed. Pathophysiological mechanisms involved in post-traumatic syrinx formation and its development were discussed. We prefer hypothesis proposed by Ball and Dayan to Gardner's hydrodynamic theory regarding to development of the syrinx secondary to spinal cord injury.

Topics: Female; Humans; Laminectomy; Metrizamide; Middle Aged; Myelography; Paraplegia; Spinal Cord Injuries; Syringomyelia; Tomography, X-Ray Computed

A series of 605 myelographies with metrizamide was reviewed to assess the risk of local injury caused by the puncture and injection of metrizamide. A lesion below the normal level of the medullary conus was found in 139 patients, and in 10 of these the needle went into or through the lesion. One patient developed paraplegia due to the puncture and injection, no other patient had any symptoms. It is concluded that in spite of the risk, lumbar puncture should be the routine procedure for myelography with metrizamide in children.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Metrizamide; Myelography; Needles; Paraplegia; Risk; Spinal Canal; Spinal Puncture