Cortical blindness after metrizamide myelography. Report of a case and proposed pathophysiologic mechanism

J. G. Smirniotopoulos, F. M. Murphy, D. Schellinger, J. F. Kurtzke and F. T. Borts

Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelography. We saw a patient with cortical blindness, seizure, organic psychosis, and asterixis after undergoing attempted metrizamide myelography via C1-2 puncture. Computed tomography demonstrated early penetrance of metrizamide into the brain parenchyma, most prominently in the occipital lobes. A mechanism of direct metrizamide neurotoxicity was proposed.

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