To the Editor. —We recently saw a patient whose clinical findings seem to corroborate the opinion of Miller et al1 regarding bilateral sixth-nerve palsy as a rare complication of water-soluble myelography. They thought that this clinical syndrome was not limited to a specific type of contrast agent. It was subsequently pointed out by Baker2 that all the patients of Miller had received iophendylate, which is not water-soluble.
Report of a Case.
—A 36-year-old man sustained a whiplash-type injury in July 1983, and he subsequently complained of intermittent left arm weakness. He underwent myelography in November 1983, performed with a 21-gauge needle using metrizamide as the contrast agent. The patient experienced a severe, postmyelography headache. One week after myelography, he noted the onset of horizontal diplopia. His visual acuity was 6/6 OU. He had 40 diopters of esotropia in primary gaze with almost complete bilateral abduction deficits. Forced duction
Perlman EM, Barry D. Bilateral Sixth-Nerve Palsy After Water-Soluble Contrast Myelography. Arch Ophthalmol. 1984;102(7):968. doi:10.1001/archopht.1984.01040030776009