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November 19, 1982

Metrizamide Cisternography

JAMA. 1982;248(19):2451. doi:10.1001/jama.1982.03330190021017

To the Editor.—  The exchange of opinions by Jahnke and Wesolowski (1982; 247:2779) regarding metrizamide cisternography in the diagnosis of the empty sella syndrome carries some important considerations. Medical literature reports many adverse reactions that include generalized and/or complex partial seizures, asterixis and encephalopathy, confusion, and speech disturbances as well as less disturbing reactions such as headaches, nausea, vomiting, and generalized malaise. Fortunately, the more serious complications are infrequent, occurring in less than one in 100 cases. Complications last up to 48 hours without recurrences. Metrizamide is a substantial advance in the radiological diagnosis of the nervous system. The incidence of complications is increased by increasing the total amount of metrizamide used. It should be noted that more metrizamide must be used to image the cerebral cisterns if it is introduced by the lumbar route rather than by the cervical route. More than 50 published reports of the intrathecal use