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USEFULNESS AND ADVERSE EFFECTS OF INTRATHECAL METRIZAMIDE INSTILLATION Hideaki Masuzawa 1 , Hiroyuki Shimizu 2 , Keiji Sano 2 1Department of Neurosurgery, Kantoh Teishin Hospital 2Department of Neurosurgery, University of Tokyo Hospital pp.843-854
Published Date 1979/8/1
DOI https://doi.org/10.11477/mf.1406204458
  • Abstract
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Radiographic quality as well as adverse effects of intrathecal metrizamide instillation was pro-spectively investigated in thirty-three clinical cases admitted to the department of neurosurgery, University of Tokyo Hospital, and Kantoh Teishin Hospital.

Metrizamide CT cisternography was performed in fifteen cases using in most cases 10 ml of 170 mg I/m/ solution through lumbar route. Eleven cases exhibited "normal"pattern CSF circulation and the remaining four,"delayed"pattern. Eight cases (53%) experienced headache, nausea, and/or vomiting several hours after the instillation. All of these belong to the"normal "pattern group. Four cases of "normal"pattern received electro-encephalographic examinations before and after metrizamide instillation. Three revealed appearance of negative spike and slow wave burst or sharp waves one to twenty-four hours after the instilla-tion, along with penetration of metrizamide into brain parenchyma. Diagnostic quality was inter-preted as"good"in eleven cases. Small acoustic neurinoma, pituitary adenoma, arachnoid cyst, and subdural hygroma were diagnosed among others.

Metrizamide ventriculography was done in four cases. No untoward effect of significance was attributed to metrizamide per se.

Cervical myelography and/or CT myelography was done in fourteen cases using, in most cases, 10 ml of metrizamide 170 mgI/m/. Polytome tomography with metrizamide instillation through lateral cervical puncture was highly diagnostic, whereas, ordinary X-ray with lumbar instillation yielded less satisfactory results. CT myelography in cases of subarachnoid block required good con-sideration on instillation site and positioning of the patient. Six cases (50%) among twelve cases where metrizamide had run into the cranial cavity experienced headache, nausea, and/or vomiting to a lesser degree than those of cisterno graphy.

Metrizamide is the first contrast agent ever made which can be safely introduced into human sub-arachnoid space, if administered judiciously. nervous

However, metrizamide is weakly toxic to central system and provokes minor untoward effects as well as electroencephalographic abnormalities and, sometimes, clinical convulsive seizure.

It would be wiser to restrict the dosage of metrizamide in cisternographic study, expecially in cases of "normal"pattern CSF circulation, to 1.2 gI or 7 ml of 170 mg I/m/ solution. Routine use of X-ray cisternography should thus be dis-couraged because it needs higher concentration of metrizamide in the intracranial cisterns.


Copyright © 1979, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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