metrizamide and Vomiting

The article reports on experiences collected with intrathecal contrast amplification in computerised tomography, using the nonionic contrast media metrizamide and iopamidol in a total of 80 examinations. The side effects are caused by the examination technique - which is discussed in detail -, the pathophysiology of CSF dynamics and the pharmacodynamics of the contrast media, but such side effects can be kept low if the relevant principles are observed. This makes the method both feasible and valuable.

Topics: Cerebral Ventriculography; Contrast Media; Humans; Hydrocephalus; Intracranial Pressure; Iopamidol; Iothalamic Acid; Metrizamide; Nausea; Posture; Tomography, X-Ray Computed; Vomiting

After undergoing myelography with iopamidol by either direct puncture (n = 120) or lumbar puncture and run up of the contrast medium (n = 232), the patients were randomly allocated into one of two groups, one group being confined to bed for 24h and the other allowed to be fully ambulant. Questionnaires recording the occurrence and severity of side effects were completed at specific intervals after the myelogram. Adverse reactions experienced were significantly fewer than in our previous direct puncture study using metrizamide. Neither in the direct puncture nor in the run up group were side effects adversely affected by allowing the patients to remain ambulant after the examination. There is, therefore, no necessity to confine patients to bed following cervical myelography.

Topics: Bed Rest; Contrast Media; Dizziness; Female; Headache; Humans; Iopamidol; Iothalamic Acid; Male; Metrizamide; Myelography; Nausea; Posture; Prospective Studies; Random Allocation; Spinal Puncture; Time Factors; Vomiting

Diagnostic quality of radiographs and adverse reactions associated with the use of metrizamide and iohexol as contrast agents in lumbar myelography were compared in a prospective randomized double blind study in 350 patients at seven centers. The contrast media were administered in comparable volumes at a concentration of 180 mg I per ml. Overall quality of radiographic visualization was graded good or excellent in 95% of 175 metrizamide studies and in 98% of 175 iohexol studies. Ninety-three patients examined using metrizamide (53%) and 130 patients examined using iohexol (74%) experienced no discomfort during or after myelography. Postmyelographic headache was associated with 38% of metrizamide examinations and 21% of iohexol examinations. Nausea and vomiting were also more common with metrizamide. Five patients examined using metrizamide (3%) experienced transient confusion and disorientation following lumbar myelography. No such reactions were observed following iohexol myelography.

Topics: Adolescent; Adult; Aged; Chemical Phenomena; Chemistry; Clinical Trials as Topic; Contrast Media; Double-Blind Method; Female; Headache; Humans; Injections, Spinal; Iodobenzoates; Iohexol; Male; Metrizamide; Middle Aged; Multi-Institutional Systems; Myelography; Nausea; Prospective Studies; Spinal Cord Diseases; Triiodobenzoic Acids; Vomiting

A randomised blind trial comparing Iopamidol (Niopam) and Metrizamide (Amipaque) for lumbar radiculography was performed in 100 patients. Significantly more patients receiving Metrizamide complained of having severe headaches (P less than 0.05) and vomiting (P less than 0.05). There was no difference in quality of the radiculograms.

Topics: Clinical Trials as Topic; Headache; Humans; Iopamidol; Iothalamic Acid; Lumbosacral Region; Metrizamide; Myelography; Random Allocation; Vomiting

A clinical assessment of metrizamide (Amipaque) lumbar myelography in 150 patients is reported, and the adverse reactions encountered are presented and discussed. Minor adverse reactions--headache (48%), nausea (10%) and vomiting (7%)--were common, and the incidence reflected overseas experience. Severe headache occurred in a significant proportion of patients (20%), despite adequate hydration and the use of a small-gauge needle. There were no major adverse reactions such as epilepsy or severe muscle spasm. The study suggests that metrizamide is well tolerated, gives good anatomical demonstration and should replace iophendylate (Myodil) in this region. Recent reports of occasional, but sometimes severe, neurological complications indicate that further cautious assessment is required.

Topics: Adolescent; Adult; Aged; Child; Clinical Trials as Topic; Female; Headache; Humans; Lumbosacral Region; Male; Metrizamide; Middle Aged; Myelography; Nausea; Vomiting

A retrospective study of 50 patients was undertaken to observe the postoperative side effects experienced by patients undergoing metrizamide (Amipaque) myelography followed by laminectomy on the same day and to compare them with side effects experienced if the laminectomy was postponed at least one day. Results documented that the incidence of nausea was statistically greater in Group 1 (myelogram and surgery the same day) than in Group 2 (delayed surgery). While the occurrence of vomiting and headache in Group 1 was also greater, the numbers did not reach statistical significance. Group 1 did require significantly more doses of antiemetics for a longer period of time. The groups did not differ in the length of time an intravenous (IV) infusion was in place, but Group 1 patients required a significantly greater number of urinary catheterizations for retention and residual for longer than three days. The length of stay and the time from surgery to discharge was the same for both groups.

Topics: Adult; Aged; Female; Headache; Humans; Laminectomy; Male; Metrizamide; Middle Aged; Myelography; Nausea; Postoperative Complications; Retrospective Studies; Vomiting

The effect of route of hydration on the severity of side effects of nausea, vomiting, and headaches for 13 patients receiving a metrizamide myelogram was studied. Six patients were hydrated by mouth only and seven by mouth and intravenously. Severity was measured 24 hours postmyelogram with a visual analogue scale for each side effect. Controlling for the volume of all fluid received, significantly more severe headaches were reported by patients hydrated only orally. For this small sample, no significant differences were found for severity of nausea or vomiting. The study and its implications for nursing are described.

Topics: Administration, Oral; Adult; Aged; Female; Fluid Therapy; Headache; Humans; Infusions, Intravenous; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Metrizamide; Middle Aged; Myelography; Nausea; Vomiting

Topics: Adult; Double-Blind Method; Female; Humans; Male; Metoclopramide; Metrizamide; Myelography; Nausea; Placebos; Random Allocation; Safety; Vomiting

Topics: Adolescent; Adult; Aged; Female; Headache; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea; Vomiting

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

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

Topics: Adult; Headache; Humans; Intervertebral Disc Displacement; Male; Metrizamide; Movement Disorders; Myelography; Nausea; Vomiting

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

Thirty-four patients were submitted to the conventional cervical myelography by administration of metrizamide (Amipaque) through three routes (lumbar 23, suboccipital 6, C1-C2 lateral 5). After the injection of metrizamide (4-11 ml, 170-250 mgI/ml), all procedures of the cervical myelography were done as soon as possible within 9 minutes. The adverse reactions of Amipaque were observed in 29 cases (85%) out of 34 cases initially 1 hour after cervical myelography and disappeared completely in an average of 16 hours. The total number of the side effects was 140 incidences such as meningeal irritation (headache 18, nausea 17, vomiting 17), cerebellar signs (dizziness 11, dysarthria 8, tremor 5, bradylalia 2, dysmetria 2, tipsy feeling 2, dysdiadochokinesis 1), autonomic signs (flushing 7, pale face 4, fever 4, sweating 2, hiccup 2, fatigability 2, micturition disturbance 1), sensory signs (exacerbation of numbness 6, perioral numbness 3, back pain 1, chest pain 1), motor signs (focal muscle spasm 5, exacerbation of paresis 4, areflexia 1), psychiatric signs (dysphasia 3, disturbance of consciousness 2, euphoria 1, persecutory delusion 1) and muddiness 7. We observed that waxing and waning of side effects correlated tightly with transient cortical penetration of dye in CT and cortical dysfunction mainly slowing of the background activity and slow wave burst in EEG. According to high frequency of side effects in our study, we suggest that a greater incidence of side effects may result when high concentration of Amipaque comes in contact with the cerebral cortex by using an inadequate fluoroscopic table which has only fixed one plane image and rough positioning control. Slow absorption into blood stream may affect appearance and maintenance of side effects. In order to decrease side effects after Amipaque cervical myelography, we propose that we should introduce a mobile rotating chair coupled with high power image and chose C1-C2 lateral route using 1500-1700mgI of Amipaque.

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

Detailed analysis of complications in 363 patients undergoing myelography with metrizamide is presented. Patients have been separated into three groups: those who had lumbar myelograms via lumbar puncture; patients who had cervical myelograms via lumbar route and patients who had cervical myelograms via cervical puncture (lateral C1/C2. approach). Analysis has revealed that the incidence of minor complications like headaches, nausea, and vomiting is higher than that associated with myodil myelography. Nevertheless, it is concluded that because of lack of long term disability of arachnoiditis, and because of greater diagnostic accuracy, metrizamide represents the best contrast medium for myelography currently available.

Topics: Adolescent; Adult; Aged; Arachnoiditis; Drug Evaluation; Female; Headache; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea; Seizures; Spinal Puncture; Vomiting

A case of rupture of a normal spleen caused by vomiting following a metrizamide myelogram is presented. The pathological, clinical and radiological features are similar to those found in traumatic splenic rupture. It is important to be aware that the normal spleen can be ruptured by relatively minor trauma as delay in diagnosis and treatment result in high morbidity and mortality.

Topics: Adult; Humans; Male; Metrizamide; Myelography; Spleen; Splenic Rupture; Vomiting

This prospective study of 90 patients after lumbar metrizamide myelography indicates that the semiupright position at 45 degrees in bed or early ambulation reduces postprocedure vomiting but does not reduce the frequency of headache. Ambulatory patients have less frequent nausea than patients kept in bed.

Topics: Female; Headache; Humans; Male; Metrizamide; Myelography; Nausea; Posture; Prospective Studies; Vomiting

Two cases are presented in which metrizamide refluxed into the lateral ventricles after vomiting, the contrast having been brought in intrathecally by lumbar route for CT-scanning of the basal cisterns. It is suggested the intrathoracic and intraabdominal pressures transority achieved in vomiting are transmitted to the spinal canal through the vertebral venous plexus. This results in a pressure which is transmitted through the C.S.F. to the posterior fossa, and from there, for anatomical reasons, to the ventricular system. Transitory dilatation of the ventricles results in aspiration fluid from the fourth ventricle, and hence reversal of normal flow in the aqueduct of Sylvius.

Topics: Cerebral Ventricles; Female; Humans; Metrizamide; Middle Aged; Subarachnoid Space; Tomography, X-Ray Computed; Vomiting

To avoid disantvantages and possible late reactions of oily contrast medium we performed 18 Meatocisternographies using the watersoluble contrast medium Metrizamide (Amipaque). Anti-convulsive premedication and clinical observance over a period of 24 h are necessary due to adverse reactions.

Topics: Adult; Cerebellar Neoplasms; Cerebellopontine Angle; Cisterna Magna; Dizziness; Dysarthria; Electroencephalography; Electronystagmography; Female; Headache; Humans; Injections, Spinal; Male; Metrizamide; Middle Aged; Nausea; Paresthesia; Radiography; Seizures; Vomiting

The diagnostic quality and side effects of Amipaque and Pantopaque as myelographic contrast agents were compared prospectively using the identical protocol in 167 cases (117 Amipaque, 50 Pantopaque). Good ratings were attained in 74% of Amipaque and 76% of Pantopaque examinations. Demonstration of nerve rootlets in the cauda equina and filling of lumbar root sleeves were superior with Amipaque. Amipaque more easily demonstrated the high posterior cervical subarachnoid space and the anterior and posterior margins of the cervical spinal cord. The incidence of postmyelographic headache was 38% with Amipaque and 32% with Pantopaque. Nausea and vomiting were more common with Amipaque. Two patients experienced grand mal seizures after examination sith Amipaque.

Topics: Adolescent; Adult; Aged; Cauda Equina; Chemical Phenomena; Chemistry; Epilepsy, Tonic-Clonic; Female; Headache; Humans; Iodobenzenes; Iophendylate; Male; Metrizamide; Middle Aged; Myelography; Nausea; Spinal Nerve Roots; Vomiting

Metrizamide is a nonionic water-soluble contrast medium for neuroradiological studies that is less irritating to the nervous system than other water-soluble agents. Studies in adults have shown that metrizamide has advantages over currently available media, but experience with children has been limited. Sixty-two children have had myelography or ventriculography using metrizamide. The children ranged in age from 11 days to 22 years. Technically satisfactory studies were obtained in every patient. No major complications were encountered. Minor side-effects included headache in 11 children (18%), mild nausea or vomiting in 16 children (26%), and fever in 4 children (6%). Seizures did not occur. One infant in the study subsequently died of unrelated problems; there was no evidence of arachnoiditis at postmortem examination. Metrizamide is a safe, effective contrast medium for neuroradiological use in children.

Topics: Adolescent; Adult; Age Factors; Cerebral Ventriculography; Child; Female; Fever; Headache; Humans; Metrizamide; Myelography; Nausea; Vomiting

Twenty pediatric and 180 adult patients underwent myelography using metrizamide (Amipaque). All patients were examined and interviewed before and after the studies. New or exacerbated symptoms attributed to metrizamide myelography were graded according to severity. After the procedure, 51 of 200 patients were unchanged from baseline. Headache was the most common complaint, with an overall incidence of 62%. Nausea and/or vomiting occurred in 38%. Back or leg pain, neck stiffness, temperature elevation, and a variety of less common manifestations were also observed. The incidence of sequelae was higher than in comparable Scandinavian studies with this contrast medium.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Fever; Follow-Up Studies; Headache; Humans; Infant; Male; Metrizamide; Middle Aged; Myelography; Nausea; Vomiting

The authors describe a simple myelographic technique for cervical spinal cord injuries, involving lateral puncture at C1--C2 and injection of metrizamide with the patient supine. This technique is reliable and offers advantages over Pantopaque and/or gas myelography.

Topics: Adolescent; Adult; Aged; Female; Headache; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea; Spinal Cord Injuries; Vomiting

Two-hundred-fifteen patients were evaluated with metrizamide, a new water-soluble contrast agent for use in the subarachnoid spaces. Side effects were reported in 67% of these; 39% were moderate or severe. Cervical injections monitored by fluoroscopy provide the most precise positioning of the medium. The benefits of metrizamide use outweigh its risk.

Topics: Cerebrospinal Fluid; Contrast Media; Headache; Humans; Iodobenzoates; Metrizamide; Myelography; Nausea; Seizures; Vomiting

In a comparative study between Dimer X and Amipaque (metrizamide) for lumbar myelography it was found that there is a little higher frequency of monor, but unimportant side effects after Amipaque. Amipaque has also been used for thoracocervical myelography with excellent results and without greater discomfort than after myelography in the lumbar region. A new puncture technique was used for the eximation of the cervical region alone: lateral puncture on the neck between the laminae of C1 and C2 under TV control. In more than 75 reinvestigations no arachnoid changes were observed.

Topics: Adult; Aged; Female; Fever; Headache; Humans; Iodobenzoates; Iothalamate Meglumine; Iothalamic Acid; Lumbosacral Region; Male; Metrizamide; Middle Aged; Myelography; Nausea; Neck; Seizures; Subarachnoid Space; Surveys and Questionnaires; Urination Disorders; Vomiting

Topics: Cerebral Ventriculography; Contrast Media; Drug Tolerance; Electroencephalography; Electromyography; Headache; Humans; Iodobenzoates; Iothalamate Meglumine; Metrizamide; Myelography; Nausea; Vomiting