Use of a 22-gauge Whitacre needle to reduce the incidence of side effects after lumbar myelography: a prospective randomised study comparing Whitacre and Quincke spinal needles.

In a prospective study lumbar iohexol myelography was performed in 107 consecutive patients, randomised for lumbar puncture with a Quincke or Whitacre spinal needle. All patients answered a questionnaire about possible side effects. Data from 100 patients (58 men, 42 women) were evaluated. In the Quincke group (n = 53), 23 (43%) reported no side effects. In the 30 patients who reported various side effects, post-dural puncture headache (PDPH) occurred in 22 (42%), of whom 9 had mild, 6 moderate and 7 (13%) severe cephalalgia, 18 (34%) reported increased low back pain/sciatica, 5 nausea and 7 dizziness. In the Whitacre group (n = 47), 33 (70%) had no side effects. PDPH was reported by 9 patients (19%), of whom 2 had mild, 6 moderate and only 1 (2%) severe cephalalgia, 4 (9%) reported increased low back pain/sciatica, 5 nausea and 4 dizziness. The conclusion drawn from this study is that lumbar myelography performed with the Whitacre spinal needle reduces postspinal side effects.

Encephalopathy and polyneuropathy induced by organic solvents.

Twenty-six patients with previous heavy exposure to organic solvents were admitted to a neurological department during a 1 1/2 year period. They were studied with a battery of tests, including general medical and neurological examinations, neuropsychological tests, electroencephalography (EEG) and neurography with electromyography (EMG), and cerebral computerized tomography (CT). The presenting complaints were compatible with encephalopathy and/or polyneuropathy. When patients with alternative diagnosis were excluded, 17 patients (65%) of the initial group were diagnosed as belonging to the organic solvent syndrome. These patients had a mean time of solvent exposure of 23.9 years, ranging from one to 45 years. EEG and cerebral CT showed minor deviations only as did the neurological examination. These methods proved nevertheless of importance in excluding alternative etiologies. Neuropsychological test performances were markedly reduced, especially short-term memory. All patients were injured by occupational exposure to organic solvents, most often from painting and lacquering. Encephalopathy was a more frequent finding than polyneuropathy, and most often classified as slight or marked, whereas severe encephalopathy was not found in the present group.

[Ambulatory radiculography (lumbar myelography) with iohexol]. / Poliklinisk radikulografi (lumbal myelografi) med ioheksol.

Iohexol lumbar myelography was performed in 133 consecutive patients remitted to a private radiological institute on an outpatient basis. Adverse reactions were recorded during the first week after myelography. The data were collected through a questionnaire returned by the patients. The results showed that half (48%) of all patients had no side effects. Some more than one third (41%) of all patients had only mild or moderate side effects from the ambulatory myelography. Of all patients 11% experienced headache or other bothersome symptoms for more than three days following myelography. In this material there was no difference in side effects between women and men. About half of the patients was punctured with a 22 gauge spinal needle and the others with a 25 gauge needle. There was no significant difference in side effects related to needle size. Iohexol lumbar myelography can safely be performed without hospitalization of the patient.