Ceguera cortical y amnesia global transitoria luego de arteriografía con iopamidol en miembro superior / Transient cortex blindness and global amnesia after performing left arm arteriography using iopamidol

RESUMEN Los medios de contraste iodados pueden presentar diferentes efectos adversos, siendo los más frecuentes daño renal y reacciones de hipersensibilidad. La ceguera cortical y amnesia global transitoria son complicaciones neurológicas raras descritas tras la administración de medios de contraste. Reportamos el caso de un paciente de 63 años, hipertenso que acude por cianosis, frialdad del segundo y tercer dedo de mano izquierda. Es sometido a arteriografía de miembro superior, usando 50 mL de iopamidol e inmediatamente desarrolla cefalea occipital asociada a visión borrosa bilateral que progresa rápidamente a ceguera; la tomografía cerebral reveló hiperdensidades subaracnoideas occipitales, sin efecto de masa. A las dieciocho horas del evento, el paciente presenta amnesia anterógrada con persistencia de amaurosis. Su tomografía cerebral de control no muestra trastornos focales. El paciente cursa con evolución favorable, la amaurosis bilateral y la cefalea ceden a las treinta horas del evento y es dado de alta sin mayores eventualidades a los diez días.

ABSTRACT Iodinated contrast substances may cause different adverse events, most frequently renal involvement and hypersensitivity reactions. Transient cortical blindness and global amnesia are rarely described neurological complications after the administration of contrast substances. We report the case of a 63-year old patient with high blood pressure who presented with cyanosis and cold sensation affecting the second and third digits of his left hand. The patient underwent an arteriography of the left arm, where 50-mL of iopamidol was used as a contrast substance, and he immediately developed occipital headache associated to bilateral blurred vision that rapidly progressed to blindness. A cerebral computed tomography (CT) scan showed occipital subarachnoid hypodense areas, with no mass effect. Eighteen hours after the event, the patient showed retrograde amnesia with persistent amaurosis. His control cerebral CT scan did now show any focal disorder. The patient had a good progression, both bilateral amaurosis and headache subsided thirty hours after the event, and the patient was uneventfully discharged after ten days.

Effect of two different doses of iopamidol enhancement on liver CT / 中国生化药物杂志

Objective To investigate and analyze the effect of two different doses of iopamidol enhancement on hepatic CT. Methods In Lishui people's hospital from January 2014 to August 201680 patients who accept hepatic enhancement scan were randomly divided into two groups, the study group and the control group, 40 cases in each group. The control group were received liver CT scan with iopamidol as contrast agent, the concentration was 300 g/L, the dosage was 1.5mL/kg, the concentration and dosage in the study group was respectively 300g/L and 1.2mL/kg. The enhancement effect after scanning in the two groups were observed and compared. Results The imaging quality in arterial phase and in portal phase in the study group were better than those in the control group (P<0.05); The adverse reactions in the study group were more than those in the control group, the difference between the two groups was statistically significant(P<0.05). Conclusion In liver CT scanning process, iopamidol as the contrast agent, the enhancement effect of 1.5mL/kg of iopamidol is better than 1.2mL/kg of iopamidol, but the efficiency scanning effect is improved at will also increase allergies and other adverse reactions..

The Preventive Effects of N-Acetylcysteine on Contrast-Induced Nephropathy in Patients Undergoing Elective Percutaneous Coronary Intervention / 天津医药

Objective To investigate the preventive effect of N-acetylcysteine (NAC) on contrast-induced nephropa-thy (CIN) in patients undergoing elective percutaneous coronary intervention (PCI). Methods A total of 521 patients under-went PCI in Tianjin were randomly divided into conventional treatment group (n=261) and NAC treatment group (n=260). NAC treatment group was given oral NAC (600 mg twice daily) for 48 h and 72 h before PCI plug hydration therapy, and the conventional treatment group was given only hydration therapy. The serum levels of creatinine(Scr), urea nitrogen(BUN), creatinine clearance rate (Ccr), C-reactive protein (CRP),β2-microglobulin(β2-MG), tumor necrosis factor-α(TNF-α), inter-leukin-6 (IL-6), superoxide dismutase (SOD), glutathione peroxidase (GPX) and incidence of CIN were detected at admission and 72 h after the procedure. Results (1) There was no significant difference in the incidence of CIN between NAC treat-ment group (6.2%) and conventional treatment group (3.8%,χ2=1.48, P>0.05). (2) There were no significant differences in se-rum levels of Scr, BUN, Ccr, CRP,β2-MG, TNF-α, IL-6, SOD and GPX before PCI ( P>0.05). (3) The serum levels of CRP, SOD and GPX were significantly higher 72 h after the procedure in two groups ( P＜0.05). There were significantly lower se-rum levels in CRP, SOD and GPX in NAC treatment group than those of conventional treatment group ( P＜0.05). There were no significant differences in serum levels of Scr, BUN,β2-MG and Ccr between NAC treatment group and conventional treat-ment group ( P >0.05). Conclusion N-acetylcysteine may have no beneficial effect on the prevention of CIN after PCI.

Phase III Clinical Trial Comparing Iopamidol 250 mgI/mL and Iopamidol 300mgI/mL in Cerebral Angiography: Multicenteric, Randomized and Double Blind Study

PURPOSE: To evaluate and compare the safety, tolerance and the image quality of cerebral angiography images with the use of the nonionic monomeric contrast agent, iopamidol at 250 mgI/mL or 300 mgI/mL. MATERIALS AND METHODS: This study was approved by the institutional review board and was performed from December 2005 to March 2006. A total of 90 patients undergoing an elective cerebral angiography were studied during a phase III clinical trial to compare the safety and diagnostic efficacy of iopamidol at 250 mgI/ml and 300 mgI/ml. The overall quality of cerebral angiography images was independently graded into three categories: good, bad and nondiagnostic by two radiologists. RESULTS: The image quality of the cerebral angiography was good in 100% of the patients in both groups. A total of 4.44% of the patients experienced adverse events (4.44% in the iopamidol 250 group and 4.44% in the iopamidol 300 group). No statistically significant differences were observed between the two studied groups for either the proportion of patients with one or more adverse events or the intensity of the adverse events. CONCLUSION: The safety and efficacy (quality of the radiographic diagnostic visualization) of Iopamidol at 250 and 300 mg I/ml did not reveal any significant differences and thus are comparable.

Spontaneous Spinal Epidural Hematoma: Report of Two Operative Cases

Spontaneous spinal epidural hematoma is a rare disease. Typically, a healthy man engaging in usual activity of daily life develops back or neck pain suddenly and most victims are unable to walk within 6 hours. We treated two cases of spontaneous spinal epidural hematoma surgically. On case developed hematoma in the thoracolumbar junction in a adult man, and the cause of hematoma could not be confirmed with surgery. Another case developed hematoma in the midthoracic area in a boy, and the source of bleeding was confirmed as arteriovenous malformation in spinal epidural fat tissue. Related literatures were reviewed.

Iopamidol Myelography

In a comparative, prospective randomized study 200 patients underwent myelography using iopamidol (150 patients) or metrizamide (50 patients) as contrast medium. Adverse reactions were few, mild, and short in duration in iopamidol myelography compared to metrizamide myelography. Seizure occured in 2 patients with the use of metrizamide. Iopamidol appears to be superior to metrizamide for intrathecal administration.

A Clinical Trial of Iopamidol Myelography in 27 Cases

27 Myelographies with Iopamidol and 27 myelographies with metrizamide were performed in order to compare adverse reactions, radiographic quality and effects on vital signs of the two contrast media after injection into the spinal subarachnoid space. Headache and nausea were less severe using Iopamidol. The most striking difference was found in adverse neurobehavioral reactions and associated electroencephalographic abnormalities which were noted in 7.4% of the metrizamide group but were not seen with the use of Iopamidol. Iopamidol was more stable than metrizamide in CSF. Image quality and diagnostic accuracy of Iopamidol myelography was equivalent to metrizamide for intrathecal application.