Iohexol in paediatric myelography

Summary

Iohexol was introduced by lumbar puncture in a series of 148 consecutive children aged between 5 days and 16 years referred for myelography; no patient was excluded. Initially, iohexol 180 mgI/ml was used in dosage proportional to body weight varying between 5 ml and 15 ml. During the later part of the trial concentration of iodine was increased to 240 mg/ml for cases in which the dorsal region was of particular interest (69 patients) and to 300 mg/ml for 8 cervical studies. The total dose ranged up to 4.8 g and varied between 0.03 g and 0.51 gI/kg body weight. In all patients, neurological examinations were performed before and at 24 h and observations for adverse reactions continued over a period of 48 h. The contrast medium was run up to the foramen magnum or basal cisterns in 128 patients and to the upper dorsal region in the other 20. In the first 62 patients vital studies were performed over the period of the myelogram and for 24 h following, and an additional limited neurological examination was made at 6 h, and in the first 26 cases of the series EEG's were done before and at 24 h after the myelogram. Minor variations in pulse rate and blood pressure were observed but these were not of sufficient magnitude to be of clinical significance. In 7 patients there was minor, generally slow wave abnormality on the EEG taken after the procedure, but no spike or epileptogenic activity was obserse reactions. Focal increase in neurological signs, associated with backache and probably related to the mechaniccs of lumbar puncture and myelography, occurred in 3 tumour patients; otherwise no change in neurological condition was observed in any case. Minor reactions were observed in 24 other patients (16.2%); vomiting 14 (9.5%), headache 8 (5.7%), backache 6 (4.1%), stomache ache 2 (1.5%), mild pyrexia 3 (2.0%). The incidence and severity of these reactions was considerably less than with metrizamide myelography and all resolved within 2 days of the iohexol injection. In conclusion, iohexol has significant advantages over previously used non-ionic contrast media and is suitable for paediatric myelography.