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[Side effects of metrizamide (Amipaque) cervical myelography (author's transl)]
Abstract:
Thirty-four patients were submitted to the conventional cervical myelography by administration of metrizamide (Amipaque) through three routes (lumbar 23, suboccipital 6, C1-C2 lateral 5). After the injection of metrizamide (4-11 ml, 170-250 mgI/ml), all procedures of the cervical myelography were done as soon as possible within 9 minutes. The adverse reactions of Amipaque were observed in 29 cases (85%) out of 34 cases initially 1 hour after cervical myelography and disappeared completely in an average of 16 hours. The total number of the side effects was 140 incidences such as meningeal irritation (headache 18, nausea 17, vomiting 17), cerebellar signs (dizziness 11, dysarthria 8, tremor 5, bradylalia 2, dysmetria 2, tipsy feeling 2, dysdiadochokinesis 1), autonomic signs (flushing 7, pale face 4, fever 4, sweating 2, hiccup 2, fatigability 2, micturition disturbance 1), sensory signs (exacerbation of numbness 6, perioral numbness 3, back pain 1, chest pain 1), motor signs (focal muscle spasm 5, exacerbation of paresis 4, areflexia 1), psychiatric signs (dysphasia 3, disturbance of consciousness 2, euphoria 1, persecutory delusion 1) and muddiness 7. We observed that waxing and waning of side effects correlated tightly with transient cortical penetration of dye in CT and cortical dysfunction mainly slowing of the background activity and slow wave burst in EEG. According to high frequency of side effects in our study, we suggest that a greater incidence of side effects may result when high concentration of Amipaque comes in contact with the cerebral cortex by using an inadequate fluoroscopic table which has only fixed one plane image and rough positioning control. Slow absorption into blood stream may affect appearance and maintenance of side effects. In order to decrease side effects after Amipaque cervical myelography, we propose that we should introduce a mobile rotating chair coupled with high power image and chose C1-C2 lateral route using 1500-1700mgI of Amipaque.
Insights
High incidence of adverse reactions occurred during metrizamide (Amipaque) cervical myelography. Researchers suggest improved equipment and C1-C2 lateral route to minimize side effects.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cervical myelography is a diagnostic imaging technique.
- Metrizamide (Amipaque) is a contrast agent used in myelography.
- Adverse reactions can occur following contrast administration.
Purpose of the Study:
- To evaluate the incidence and nature of adverse reactions following conventional cervical myelography using metrizamide.
- To identify factors contributing to these side effects.
- To propose methods for reducing adverse events.
Main Methods:
- Thirty-four patients underwent cervical myelography with metrizamide via lumbar, suboccipital, or C1-C2 lateral routes.
- Adverse reactions were monitored within 1 hour post-procedure and over a 16-hour period.
- Correlation between side effects, contrast penetration on CT, and EEG findings was assessed.
Main Results:
- 85% of patients (29/34) experienced adverse reactions, with symptoms resolving in an average of 16 hours.
- Common side effects included meningeal irritation (headache, nausea, vomiting) and cerebellar signs (dizziness, dysarthria).
- Side effect severity correlated with transient cortical dye penetration and cortical dysfunction.
Conclusions:
- Conventional cervical myelography with metrizamide is associated with a high frequency of adverse reactions.
- Inadequate fluoroscopic equipment and high contrast concentration may increase side effect incidence.
- Recommendations include using a mobile rotating chair and the C1-C2 lateral route with specific contrast dosage to minimize adverse events.