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Aphasia Following Pluridirectional Tomography With Metrizamide: The Effect of Patient Position

Aphasia Following Pluridirectional Tomography With Metrizamide: The Effect of Patient Position Abstract • Eight of 67 patients became transiently aphasic after myelography or cisternography with metrizamide. All eight patients had been placed in the left lateral decubitus position for pluridirectional tomography. Immediate EEGs revealed focal left-sided abnormalities in two patients. In one other patient, a computed tomographic scan showed contrast mainly over the left hemisphere. All of the symptoms resolved within 48 hours. In 34 patients who were placed on the right side, no language disturbance was noted. Aphasia after pluridirectional tomography with metrizamide may be due to local irritation of the perisylvian language centers of the dominant hemisphere. The phenomenon is distinct from syndromes of generalized confusion. The complication may be avoided by placing patients in a right lateral decubitus position for pluridirectional tomography. References 1. Nickel AR, Salem JJ: Clinical experience in North America with metrizamide . Acta Radiol Suppl 1977;355:409-416. 2. Sackett JF, Strother CM, Quaglieri CE, et al: Metrizamide—CSF contrast medium: Analysis of clinical application in 215 patients . Radiology 1977;123:779-782.Crossref 3. Junck L, Marshall WH: Neurotoxicity of radiological contrast agents . Ann Neurol 1983; 13:469-484.Crossref 4. Rubin B, Horowitz G, Katy RI: Asterixis following metrizamide myelography . Arch Neurol 1980;37:522.Crossref 5. Russell D, Anke IM, Nyberg-Hansen R, et al: Complex partial status epilepticus following myelography with metrizamide . Ann Neurol 1980;8:325-327.Crossref 6. Shiozawa Z, Sasaki H, Ozaki Y, et al: Epilepsia partialis continua following metrizamide cisternography . Ann Neurol 1981;10:400-401.Crossref 7. Picard L, Vespignani H, Vieux-Rochat P, et al: Serious neurological complications of metrizamide myelography: Review of eight cases . J Neuroradiol 1979;6:3-14. 8. Paling MR, Quindlen EA, Di Chiro G: Spinal seizures after metrizamide myelography in spinal block . AJR 1980;135:1091-1092.Crossref 9. Bertoni JM, Schwartzman RJ, Van Horn G, et al: Asterixis and encephalopathy following metrizamide myelography: Investigations into possible mechanisms and review of the literature . Ann Neurol 1981;9:366-370.Crossref 10. Gelmers JH: Adverse side effects of metrizamide in myelography . Neuroradiology 1979;26:119-123. 11. Schmidt RC: Mental disorders after myelography with metrizamide and other water-soluble contrast media . Neuroradiology 1980, 19:153-157.Crossref 12. Killebrew K, Whaley RA, Hayward JN, et al: Complications of metrizamide myelography . Arch Neurol 1983;40:78-80.Crossref 13. Richert S, Sartor K, Holl B: Subclinical organic psychosyndromes on intrathecal injection of metrizamide for lumbar myelography . Neuroradiology 1979;18:177-184.Crossref 14. Hauge O, Falkenberg H: Neuropsychologic reactions and other side effects after metrizamide myelography . AJR 1982;139:357-360.Crossref 15. Boker DK, Sartor K, Winkler D: Motorische Aphasie nach zervikaler Myelographie mit Metrizamide . ROFO 1980;133:204-207.Crossref 16. Smith MS, Laguna JF: Confusion, dysphasia and asterixis following metrizamide myelography . Can J Neurol Sci 1980;7:309-311. 17. Chehrazi B, Virapoyse C: Transient encephalopathy and asterixis following metrizamide myelography . J Neurosurg 1981;55:826-829.Crossref 18. Bergvall U, Brismar T, Lying-Tunell J, et al: Confusion, myoclonus and speech arrest: Epileptic manifestations after metrizamide myelography . Acta Neurol Scand 1981;63:315-322.Crossref 19. Okada K, Nishimatsu T, Wada H, et al: Side effects of metrizamide (Amipaque) cervical myelography . No Shinkei Geka 1982;10:511-518. 20. Carella A, Federico F, DiCuonzo F, et al: Adverse side effects of metrizamide and iopamidolo in myelography . Neuroradiology 1982; 22:247-249.Crossref 21. Rico RE, de Weerd AW, Prick FJJ: Adverse side effects on cerebral functions after the use of metrizamide for cervical myelography . Clin Neurol Neurosurg 1982;84:65-67.Crossref 22. Masdeu JC, Glista GG, Rubino FA, et al: Transient motor aphasia following metrizamide myelography . AJNR 1983;4:200-202. 23. Eleevik OP, Nakken KO, Haughton VM: The effect of dehydration on the side effects of myelography . Radiology 1978;129:715-716. 24. Amundsen P: Metrizamide in cervical myelography . Acta Radiol Suppl 1977;355:85-97. 25. Vogelsang H, Schmidt R, Grunwald F: Die thorakale Myelographie mit wasserloslicher Kontrastmitteln (Metrizamide) . ROFO 1978; 128:342-345.Crossref 26. Sortland O, Umdervold A, Nesbakken R: Mental confusion and epileptic seizures following cervical meylography with metrizamide . Acta Radiol Suppl 1977;355:403-406. 27. McCormick CS, Apsimon HT, Chakera TM: Myelography with metrizamide: An analysis of the complications encountered in cervical, thoracic and lumbar myelography . Aust NZ J Med 1981;11:645-650.Crossref 28. Legrie J, Lavieille J, Debaiene A, et al: Prevention of adverse reactions to Amipaque in cervical myelography: Report of a homogeneous series of 380 patients . J Radiol 1981;8:353-361. 29. Laasonen E, Servo A, Soini J, et al: A new relative contraindication for lumbar myelography . Neuroradiology 1978;16:367-368.Crossref 30. Conner ES, Martuza RL, Heros RC: Seizures due to metrizamide in patients with acute cervical spine injury . Neurosurgery 1982;10:266-267.Crossref 31. Speck U, Schmidt R, Volkhardt V, et al: The effect of position of patient on the passage of metrizamide (Amipaque), meglumine iocarmate (Dimer X) and ioserinate (Myelografin) into the blood after lumbar myelography . Neuroradiology 1978;14:251-256.Crossref 32. Robertson WD, Lapointe JS, Nugent RA, et al: Positioning of patients after metrizamide lumbar myelography . AJR 1980;134:947-948.Crossref 33. Drayer BP, Rosenbaum AE: Metrizamide brain penetrance . Acta Radiol Suppl 1977; 355:280-293. 34. Vincent FM, Zimmerman JE: Metrizamide encephalopathy . Ann Neurol 1980;7:494.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Aphasia Following Pluridirectional Tomography With Metrizamide: The Effect of Patient Position

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Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1985.04060010045014
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Abstract

Abstract • Eight of 67 patients became transiently aphasic after myelography or cisternography with metrizamide. All eight patients had been placed in the left lateral decubitus position for pluridirectional tomography. Immediate EEGs revealed focal left-sided abnormalities in two patients. In one other patient, a computed tomographic scan showed contrast mainly over the left hemisphere. All of the symptoms resolved within 48 hours. In 34 patients who were placed on the right side, no language disturbance was noted. Aphasia after pluridirectional tomography with metrizamide may be due to local irritation of the perisylvian language centers of the dominant hemisphere. The phenomenon is distinct from syndromes of generalized confusion. The complication may be avoided by placing patients in a right lateral decubitus position for pluridirectional tomography. References 1. Nickel AR, Salem JJ: Clinical experience in North America with metrizamide . Acta Radiol Suppl 1977;355:409-416. 2. Sackett JF, Strother CM, Quaglieri CE, et al: Metrizamide—CSF contrast medium: Analysis of clinical application in 215 patients . Radiology 1977;123:779-782.Crossref 3. Junck L, Marshall WH: Neurotoxicity of radiological contrast agents . Ann Neurol 1983; 13:469-484.Crossref 4. Rubin B, Horowitz G, Katy RI: Asterixis following metrizamide myelography . Arch Neurol 1980;37:522.Crossref 5. Russell D, Anke IM, Nyberg-Hansen R, et al: Complex partial status epilepticus following myelography with metrizamide . Ann Neurol 1980;8:325-327.Crossref 6. Shiozawa Z, Sasaki H, Ozaki Y, et al: Epilepsia partialis continua following metrizamide cisternography . Ann Neurol 1981;10:400-401.Crossref 7. Picard L, Vespignani H, Vieux-Rochat P, et al: Serious neurological complications of metrizamide myelography: Review of eight cases . J Neuroradiol 1979;6:3-14. 8. Paling MR, Quindlen EA, Di Chiro G: Spinal seizures after metrizamide myelography in spinal block . AJR 1980;135:1091-1092.Crossref 9. Bertoni JM, Schwartzman RJ, Van Horn G, et al: Asterixis and encephalopathy following metrizamide myelography: Investigations into possible mechanisms and review of the literature . Ann Neurol 1981;9:366-370.Crossref 10. Gelmers JH: Adverse side effects of metrizamide in myelography . Neuroradiology 1979;26:119-123. 11. Schmidt RC: Mental disorders after myelography with metrizamide and other water-soluble contrast media . Neuroradiology 1980, 19:153-157.Crossref 12. Killebrew K, Whaley RA, Hayward JN, et al: Complications of metrizamide myelography . Arch Neurol 1983;40:78-80.Crossref 13. Richert S, Sartor K, Holl B: Subclinical organic psychosyndromes on intrathecal injection of metrizamide for lumbar myelography . Neuroradiology 1979;18:177-184.Crossref 14. Hauge O, Falkenberg H: Neuropsychologic reactions and other side effects after metrizamide myelography . AJR 1982;139:357-360.Crossref 15. Boker DK, Sartor K, Winkler D: Motorische Aphasie nach zervikaler Myelographie mit Metrizamide . ROFO 1980;133:204-207.Crossref 16. Smith MS, Laguna JF: Confusion, dysphasia and asterixis following metrizamide myelography . Can J Neurol Sci 1980;7:309-311. 17. Chehrazi B, Virapoyse C: Transient encephalopathy and asterixis following metrizamide myelography . J Neurosurg 1981;55:826-829.Crossref 18. Bergvall U, Brismar T, Lying-Tunell J, et al: Confusion, myoclonus and speech arrest: Epileptic manifestations after metrizamide myelography . Acta Neurol Scand 1981;63:315-322.Crossref 19. Okada K, Nishimatsu T, Wada H, et al: Side effects of metrizamide (Amipaque) cervical myelography . No Shinkei Geka 1982;10:511-518. 20. Carella A, Federico F, DiCuonzo F, et al: Adverse side effects of metrizamide and iopamidolo in myelography . Neuroradiology 1982; 22:247-249.Crossref 21. Rico RE, de Weerd AW, Prick FJJ: Adverse side effects on cerebral functions after the use of metrizamide for cervical myelography . Clin Neurol Neurosurg 1982;84:65-67.Crossref 22. Masdeu JC, Glista GG, Rubino FA, et al: Transient motor aphasia following metrizamide myelography . AJNR 1983;4:200-202. 23. Eleevik OP, Nakken KO, Haughton VM: The effect of dehydration on the side effects of myelography . Radiology 1978;129:715-716. 24. Amundsen P: Metrizamide in cervical myelography . Acta Radiol Suppl 1977;355:85-97. 25. Vogelsang H, Schmidt R, Grunwald F: Die thorakale Myelographie mit wasserloslicher Kontrastmitteln (Metrizamide) . ROFO 1978; 128:342-345.Crossref 26. Sortland O, Umdervold A, Nesbakken R: Mental confusion and epileptic seizures following cervical meylography with metrizamide . Acta Radiol Suppl 1977;355:403-406. 27. McCormick CS, Apsimon HT, Chakera TM: Myelography with metrizamide: An analysis of the complications encountered in cervical, thoracic and lumbar myelography . Aust NZ J Med 1981;11:645-650.Crossref 28. Legrie J, Lavieille J, Debaiene A, et al: Prevention of adverse reactions to Amipaque in cervical myelography: Report of a homogeneous series of 380 patients . J Radiol 1981;8:353-361. 29. Laasonen E, Servo A, Soini J, et al: A new relative contraindication for lumbar myelography . Neuroradiology 1978;16:367-368.Crossref 30. Conner ES, Martuza RL, Heros RC: Seizures due to metrizamide in patients with acute cervical spine injury . Neurosurgery 1982;10:266-267.Crossref 31. Speck U, Schmidt R, Volkhardt V, et al: The effect of position of patient on the passage of metrizamide (Amipaque), meglumine iocarmate (Dimer X) and ioserinate (Myelografin) into the blood after lumbar myelography . Neuroradiology 1978;14:251-256.Crossref 32. Robertson WD, Lapointe JS, Nugent RA, et al: Positioning of patients after metrizamide lumbar myelography . AJR 1980;134:947-948.Crossref 33. Drayer BP, Rosenbaum AE: Metrizamide brain penetrance . Acta Radiol Suppl 1977; 355:280-293. 34. Vincent FM, Zimmerman JE: Metrizamide encephalopathy . Ann Neurol 1980;7:494.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Jan 1, 1985

References