Tolerance of iohexol, iopamidol, and metrizamide in lumbar myelography

Elkin, Charles M.; Levan, Ann-Marie T.; Leeds, Norman E.

doi:10.1016/0090-3019(86)90336-8

Cited by 22 publications

(13 citation statements)

References 29 publications

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“…20 Aseptic meningitis or meningoencephalitis after iohexol myelography is very rare. In a 1986 review of the literature by Elkin et al, 4 they found no cases of serious neurologic adverse effects (defined as mental status changes or seizure) in 248 patients who underwent myelography with iohexol. In 1988, Nestvold and Sortland 21 also found no severe neurologic complications in the 331 patients reviewed who underwent iohexol myelography.…”

Section: Discussionmentioning

confidence: 98%

“…3 Newer agents such as iohexol and iopamidol replaced metrizamide, as comparative trials showed a decreased incidence of severe adverse neurologic effects with these agents. 4,5 Iohexol is a popular nonionic, water-soluble, radiographic contrast medium for myelography with an iodine content of 46.36%. Omnipaque 240, 300, and 350 contain 240 mg, 300 mg, and 350 mg of organic iodine per milliliter, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Aseptic Meningoencephalitis after Iohexol CT Myelography

Romesburg¹,

Ragozzino²

2008

AJNR Am J Neuroradiol

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SUMMARY:We describe the case of a patient with aseptic meningoencephalitis after intrathecal iohexol injection for myelography and review the previous literature on similar cases of contrastinduced neurotoxicity.A septic meningoencephalitis is a rare complication of myelography with nonionic, iodinated, water-soluble contrast agents. We describe a case of a 69-year-old woman in whom aseptic meningoencephalitis developed after she underwent iohexol myelography. Case ReportA 69-year-old white woman underwent a technically successful outpatient CT myelogram with 10 mL of iohexol (Omnipaque 300; GE Healthcare, Cork, Ireland). The CSF was clear and colorless, and myelogram revealed degenerative osteoarthritis and severe central canal stenosis at L3-L4 secondary to short pedicles, facet and ligamentum flavum hypertrophy, and diffuse disk bulging. Approximately 12 hours after the injection, she experienced fever, headache, confusion, agitation, and aphasia. She was brought to the emergency department 20 hours after the myelogram.In the emergency department, her initial temperature was 102.5°F, and she was agitated and unable to speak, though she could shake and nod her head for "yes" or "no" responses. She complained of a severe headache and low back pain but denied incontinence or lower extremity numbness. On physical examination, she had mild symmetric lower extremity weakness that measured 4 of 5 bilaterally. Her serum white blood cell count (WBC) was 24,300 cells/L (90% neutrophils). Head CT revealed moderate to severe, chronic, smallvessel ischemic disease. Lumbar puncture and CSF analysis approximately 30 hours after the iohexol injection revealed turbid-appearing fluid with 300 white cells/L (61% polymorphonuclear cells and 1% monocytes), 5200 red cells/L, glucose level of 63 mg/dL, and elevated total protein level of 624 mg/dL. A second tube of CSF from the same lumbar puncture revealed 220 white cells/L (94% polymorphonuclear cells and 2% lymphocytes) and 1545 red cells/L. Results of CSF bacterial and cryptococcal antigens were negative. CSF culture revealed no growth at 5 days.She was initially started on intravenous ceftriaxone (2000 mg) and vancomycin (1000 mg) every 12 hours. The following day, approximately 48 hours after the myelogram, she was afebrile, and her mental status and neurologic examination had returned to near baseline with fluent speech. She was alert and oriented, with no recollection of the previous day, and complained only of a bandlike headache. An infectious disease consultation was obtained, and the patient was diagnosed with an allergic reaction to the iohexol. Diagnosis was based on the negative Gram stain result, negative culture result, and rapid resolution. Antibiotics were discontinued after results of CSF tests, blood tests, and urine cultures remained negative.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Aseptic Meningoencephalitis after Iohexol CT Myelography

Romesburg¹,

Ragozzino²

2008

AJNR Am J Neuroradiol

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“…Yet, there were no cases of serious neurologic complications (defined as change in mental status and seizures) in 794 patients after myelography with either iohexol or iopamidol. 5 Since this review paper, six cases of clinically evident aseptic meningitis have been reported following the use of iohexol (n ϭ 3), iopamidol (n ϭ 2), or iotrolan (n ϭ 1) for myelography. [1][2][3][6][7][8] Initial CSF findings in these six cases (10,090 Ϯ 11,513 cells/cmm; 453 Ϯ 482 mg/dL total protein) were similar to our patient and indistinguishable from findings in bacterial meningitis.…”

Section: Discussionmentioning

confidence: 99%

Severe symptomatic aseptic chemical meningitis following myelography

Bender¹,

Elstner²,

Paul³

et al. 2004

Neurology

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Symptomatic aseptic, chemical meningitis is a rare complication of myelography. Its acute clinical course and standard laboratory findings are indistinguishable from those of bacterial meningitis. The authors present a case of severe postmyelographic chemical meningitis and compare CSF and serum inflammatory markers to a group of seven patients with proven bacterial meningitis. As in viral meningitis, procalcitonin might be able to discriminate between bacterial and chemical causes of CNS inflammation.

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“…As the introduction of nonionic water-soluble contrast medium, lumbar myelography has become a safe imaging technique with rare complications. 33 The most common adverse reaction is headache. Other reactions included nausea, vomiting, dizziness, and radicular pain.…”

Section: Invasivenessmentioning

confidence: 99%