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Transient expressive (nonfluent) dysphasia after metrizamide myelography
Abstract:
Four (3.4%) of 117 patients undergoing metrizamide myelography experienced transient expressive dysphasia 7-8 hr after myelography and lasting up to 36 hr. All four patients had lumbar myelograms obtained with 15 ml of 190 mg l/ml (2850 mg l). Metrizamide was injected via lumbar puncture with a 20 gauge spinal needle under fluoroscopic control. Neurologic complications after metrizamide have been reported, but so far have appeared to be transient. It is likely that the transient expressive dysphasia experienced by the four patients reported here was a neurotoxic reaction, rather than a seizure phenomenon.
Insights
Transient expressive dysphasia occurred in 3.4% of patients after metrizamide myelography. This neurotoxic reaction, lasting up to 36 hours, highlights potential risks of this contrast agent.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Metrizamide is a contrast agent used in myelography.
- Neurologic complications following metrizamide administration have been documented.
- The transient nature of these complications is a key characteristic.
Observation:
- Four patients (3.4% of 117) developed transient expressive dysphasia.
- Symptoms appeared 7-8 hours post-myelography and persisted for up to 36 hours.
- All affected patients received 15 ml of metrizamide (190 mg/ml) via lumbar puncture.
Findings:
- The observed expressive dysphasia is likely a neurotoxic reaction to metrizamide.
- This contrasts with a seizure phenomenon, suggesting a different mechanism of toxicity.
- The dose and administration route (lumbar puncture) were consistent among affected patients.
Implications:
- Awareness of this potential neurotoxic effect is crucial for clinicians.
- Further research may be needed to elucidate the precise mechanisms of metrizamide neurotoxicity.
- Risk-benefit assessments for metrizamide myelography should consider this adverse event.