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Seizures following myelography with iopamidol
Abstract:
Iopamidol, a water-soluble contrast medium, has been rarely associated with seizures. We describe 3 patients (from a series of 785) who had generalized tonic-clonic seizures after iopamidol myelography. Two of the patients underwent lumbar and one cervical myelography. There was a history of seizures in 2 patients, and the dose of iopamidol used in the patients who convulsed was high, ranging from 3,000 to 4,500 mg iodine. Despite the reported low incidence of complications with iopamidol, seizures may occur, especially in patients with previous seizures and also in those receiving higher doses of iopamidol.
Insights
Iopamidol myelography rarely causes seizures, but 3 patients experienced them. Risk increases with a history of seizures and higher iopamidol doses.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Iopamidol is a widely used water-soluble contrast medium.
- Seizures are a rare but reported complication of iopamidol administration.
- Myelography involves injecting contrast agents into the spinal canal.
Observation:
- Three patients (0.38%) in a series of 785 developed generalized tonic-clonic seizures post-iopamidol myelography.
- Two patients had lumbar myelography, and one had cervical myelography.
- Two of the three patients with seizures had a prior history of seizures.
Findings:
- The incidence of seizures in this series was 0.38%.
- Seizure occurrence was associated with higher iopamidol doses (3,000–4,500 mg iodine).
- A history of seizures appears to be a risk factor for post-myelography seizures.
Implications:
- While iopamidol is generally safe, clinicians should be aware of the potential for seizures.
- Careful patient selection and dose monitoring are crucial, especially in those with a seizure history.
- Further research may be warranted to fully elucidate the risk factors and mechanisms of iopamidol-induced seizures.