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Iatrogenic lateral rectus palsies. A series of five postmyelographic cases
J A Bell1, G G McIllwaine, D O'Neill
1Eye Department, King's College Hospital, Denmark Hill, London, U.K.
Abstract:
The objective of this study was to assess the etiology of lateral rectus palsies in patients undergoing lumbar myelograms with Iopamidol (Isovue; ER Squibb and Sons, Princeton, NJ, USA; Niopam, E Merc, UK.). An audit of the departmental orthoptic record revealed two patients who had suffered abducens palsies after myelograms. A further search revealed three additional patients who had suffered similar complications. The incidence of abducens palsy in patients undergoing myelography with the contrast agent Iopamidol was found to be 1 in 500 in around 2,500 myelograms performed under standard conditions. It would appear that lateral rectus palsy in myelography is the result of the lumbar puncture, the neurotoxic effect of the contrast agent, or a combination of the two in patients with an already compromised neurophysiologic state. This is the first series to associate this problem with Iopamidol. Although usually a serious neurologic symptom, when associated with contrast myelography using Iopamidol it is important to appreciate that such symptoms usually resolve of their own accord.
Insights
Lumbar myelograms using Iopamidol contrast can cause lateral rectus palsies, affecting 1 in 500 patients. These abducens nerve issues, often linked to the procedure or contrast agent, typically resolve spontaneously.
Area of Science:
- Neurology
- Ophthalmology
- Radiology
Background:
- Lumbar myelography is an imaging procedure used to visualize the spinal cord and nerve roots.
- Lateral rectus palsy, or abducens nerve palsy, affects eye movement and can be a neurological symptom.
Observation:
- An audit identified five patients experiencing abducens palsy after lumbar myelograms with Iopamidol.
- The incidence of abducens palsy following Iopamidol myelography was determined to be approximately 1 in 500.
Findings:
- Lateral rectus palsy after myelography may result from the lumbar puncture, the neurotoxic effects of Iopamidol, or a combination of factors in susceptible individuals.
- This study is the first to specifically link Iopamidol contrast agent with the occurrence of lateral rectus palsy.
Implications:
- While typically a serious neurological sign, lateral rectus palsy associated with Iopamidol myelography is generally transient and resolves without intervention.
- Awareness of this potential complication is crucial for clinicians managing patients undergoing contrast myelography.