Formed visual hallucinations after metrizamide myelography.

Area of Science:

• Neurology
• Radiology
• Ophthalmology

Background:

• Metrizamide myelography is an imaging technique used to diagnose spinal cord and central nervous system conditions.
• Downbeat nystagmus is an involuntary rhythmic eye movement that can be caused by various neurological disorders.

Observation:

• A 77-year-old woman developed visual hallucinations, including geometric shapes and human figures, 12 hours post-metrizamide myelography of the posterior fossa.
• She presented with an elevated white blood cell count (26,000/mm3) and elevated serum creatine phosphokinase (438 units/liter).

Findings:

• Hallucinations resolved within two days.
• White blood cell count decreased to 17,000/mm3 and serum creatine phosphokinase to 105 units/liter.
• The patient's symptoms likely resulted from metrizamide penetration into the temporal lobe and visual association cortex.

Implications:

• This case highlights a potential neurological side effect of metrizamide, specifically visual disturbances.
• Early identification and monitoring of inflammatory markers may be crucial in managing patients undergoing metrizamide myelography.
• Further research is needed to understand the neurotoxic effects of metrizamide and optimize patient safety.