Side Effects of Dimer-X (Methylglucamine Iocarmate) Used in Myelography -With Special Reference To Attacks of Myelospasm-
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We have 153 cases in which water-soluble contrast agents were used for lumbosacral myelography during the last year. Of these 153 cases, Conray was used in 41 and Dimer-X in the other 112.Side-effects attending the radiodiagnostic procedure using these contrast media reportedly are irritation of meninges, nerve root and spinal cord. The mechanism of development of these adverse effects may be divided roughly into 2 categories; one is mechanical effects produced by the injection of a contrast agent into the subarachnoid space (through lumbar puncture) with a consequent change in cerebrospinal pressure and the other is a direct pharmacologic action of iodine on the spinal cord. The latter mechanism explains clonic convulsions seen in 3 (7.3%) of cases with Conray and in 3 (2.6%) of those with Dimer-X (the incidence of side-effects in our series was 6/41 with the former contrast agent and 11/112 with the latter. Since Dimer-X is reasonably, but not entirely, free from adverse side effects, it is recommendable not to use it in an amount of more than 5ml. The use of diazepam, orally or by injection, for its potent anticonvulsant effect prior to the radiodiagnostic procedure is of great prophylactic value.Myelography with the use of this contrast agent does not entail any permanent changes in the spinal cord even if performed repeatedly and, accordingly, tends to be done rather frequently. Since the agent is a radiculographic one intended for filling the subdural space, roentgenologic examination by its use always requires multi-directional projections for adequate visualization of a diseased area. The remote operation of an X-ray apparatus by means of 4π scope proves to be very useful in preventing the physician from being exposed to x-ray.
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