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Mental disorders after myelography with metrizamide and other water-soluble contrast media
Abstract:
Water-soluble contrast media, which have been employed in the examination of the lumbar spinal canal for 30 years, can sometimes result in severe complications, such as arachnoiditis, epileptic seizures, and myoclonic spasm. These complications have been seen less frequently since the advent of metrizamide, a new non-ionic water-soluble contrast medium. However, a further neurological complication has now arisen--mental disorder, varying in kind and degree; for example, organic psychosis and perceptual disturbance. Some characteristic cases are described. A series of 75 patients, all of whom received varying amounts of metrizamide for the purpose of cervical, thoracic and lumbar myelography, has been studied. Seven patients were found to have a pronounced organic psychosis and three patients had visual illusions or hallucinations. It is suggested that there is some degree of correlation between the total amount of iodine received and patient age. By careful enquiry and examination, similar disturbances were also found some 4-8 h after myelography with other water-soluble contrast media.
Insights
Newer water-soluble contrast media like metrizamide reduce some risks but can cause mental disorders. Further research is needed to understand and mitigate these neurological complications during myelography.
Area of Science:
- Neurology
- Radiology
Background:
- Water-soluble contrast media have been used for lumbar spinal canal examinations for 30 years.
- Traditional contrast media can cause severe complications like arachnoiditis and seizures.
Observation:
- Metrizamide, a non-ionic contrast medium, has reduced some adverse events.
- However, metrizamide has been associated with new neurological complications, including mental disorders such as organic psychosis and perceptual disturbances.
Findings:
- A study of 75 patients undergoing myelography with metrizamide revealed 7 cases of pronounced organic psychosis and 3 with visual illusions or hallucinations.
- A correlation may exist between the total iodine dose received and patient age.
- Similar mental disturbances were observed 4-8 hours after myelography with other water-soluble contrast media.
Implications:
- The introduction of metrizamide has shifted the spectrum of neurological complications in myelography.
- Clinicians should be aware of the potential for mental disorders following contrast media administration.
- Further investigation is warranted to understand the mechanisms and risk factors for these adverse neurological events.