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Abstract:
The adverse side effects in a series of 439 myelographies with metrizamide were analyzed. The most frequent side effect was headache, which could be differentiated as early onset headache, related to hydrodynamic modifications in the spinal fluid following lumbar puncture, and late onset headache related to a metrizamide effect. The frequency of late onset headache was at least 27%, but all together 46% of the patients had postmyelographic headache. Meningeal irritation was seen in 5%, sometimes in a severe form, mimicking a septic complication. Spinal irritation and epileptic fits were rarely seen. Striking was the occurrence of an acute psycho-organic syndrome, frequently observed after cervical myelography which was performed with a higher than usual dose of iodine. We can not confirm the general opinion that the central nervous system had a good tolerance for metrizamide.
Insights
Metrizamide myelography can cause adverse side effects, including frequent headaches (46%) and psycho-organic syndromes, particularly after cervical procedures. Central nervous system tolerance to metrizamide is not as good as previously thought.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Metrizamide is a non-ionic, water-soluble contrast agent used in myelography.
- Previous studies suggested good central nervous system (CNS) tolerance to metrizamide.
Purpose of the Study:
- To analyze the adverse side effects of metrizamide in a large series of myelographies.
- To evaluate the CNS tolerance of metrizamide based on observed side effects.
Main Methods:
- Analysis of adverse events in 439 patients who underwent myelography with metrizamide.
- Categorization of side effects, including headache onset, meningeal irritation, and neurological events.
Main Results:
- Headache was the most frequent side effect (46%), with early and late onset types identified.
- Late onset headache occurred in at least 27% of patients.
- Meningeal irritation (5%) and acute psycho-organic syndromes (especially after cervical myelography) were observed.
- Rare occurrences of spinal irritation and epileptic fits were noted.
Conclusions:
- Metrizamide myelography is associated with a significant incidence of adverse effects, notably headaches and psycho-organic syndromes.
- The study challenges the notion of good CNS tolerance to metrizamide.
- Cervical myelography with higher iodine doses may increase the risk of psycho-organic syndromes.