[Myelography as a cause of persistant cerebral vascular spasm]

A few hours after an ascending myelography with Pantopaque, a woman aged 52 presented light coma with signs of meningeal reaction, left hemiparesis and a central deficit of the left facial nerve. 24 hours later, a computer axial tomography revealed the presence of the contrast media (Pantopaque) in the basal cysterns. Three days after, the right carotid angiography indicated the presence of a diffuse spasm of the intracranial branches of the internal carotid artery, particularly a spasm of the cortical ascending parietal and descending temporal ones, without deplacements. A second CT investigation revealed a slow, but complete recovery of the neurologic functions in the following 10 days. According to the Authors, this clinical observation reproduces the experimental pattern of the cerebral spasm caused by the administration of a spasmogenic chemical factor in the basal cysterns, because of the following clinical aspects: blood absence in the liquor; T wave inversion (the electrocardiographic symptom considered as a predisposing factor); meningeal reaction owing to the irritation of the myelographic contrast and persistent vasospastic answer of the right carotid circle, as it may be seen in the angiographic control.