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Abstract:
A 39-year-old man had fever, nuchal rigidity, vomiting, and mental confusion within 24 hours after myelography with metrizamide, a water-soluble contrast medium. Cloudy cerebrospinal fluid showing pleocytosis, a significantly elevated level of protein, and a low glucose value suggested septic meningitis, but rapid resolution of signs of meningeal irritation and negative spinal fluid cultures made chemical meningitis due to the metrizamide the likely diagnosis.
Insights
A patient developed symptoms mimicking meningitis after myelography. Rapid symptom resolution and negative cultures indicated chemical meningitis from metrizamide, not infection.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Myelography is an imaging procedure using contrast media to visualize the spinal canal.
- Metrizamide is a water-soluble contrast agent historically used in myelography.
- Adverse reactions to contrast media can occur, necessitating accurate diagnosis.
Observation:
- A 39-year-old male presented with acute onset fever, nuchal rigidity, vomiting, and confusion post-myelography.
- Cerebrospinal fluid analysis revealed pleocytosis, elevated protein, and low glucose, suggestive of septic meningitis.
- Clinical signs of meningeal irritation resolved rapidly within 24 hours.
Findings:
- Cultures of cerebrospinal fluid were negative for bacterial or fungal pathogens.
- The rapid resolution of symptoms and negative cultures ruled out infectious meningitis.
- Chemical meningitis induced by the metrizamide contrast agent was determined to be the most probable diagnosis.
Implications:
- This case highlights the importance of considering contrast-induced chemical meningitis in post-myelography patients.
- Accurate differentiation between infectious and chemical meningitis is crucial for appropriate patient management.
- Understanding the potential adverse effects of contrast media aids in diagnosing neurological complications.