IATROGENIC LATERAL RECTUS PALSIES - A SERIES OF 5 POSTMYELOGRAPHIC CASES

The objective of this study was to assess the etiology of lateral rect us palsies in patients undergoing lumbar myelograms with Iopamidol (Is ovue; ER Squibb and Sons, Princeton, NJ, USA; Niopam, E Merc, UK.). An audit of the departmental orthoptic record revealed two patients who had suffered abducens palsies after myelograms. A further search revea led three additional patients who had suffered similar complications. The incidence of abducens palsy in patients undergoing myelography wit h the contrast agent Iopamidol was found to be 1 in 500 in around 2,50 0 myelograms performed under standard conditions. It would appear that lateral rectus palsy in myelography is the result of the lumbar punct ure, the neurotoxic effect of the contrast agent, or a combination of the two in patients with an already compromised neurophysiologic state . This is the first series to associate this problem with Iopamidol. A lthough usually a serious neurologic symptom, when associated with con trast myelography using Iopamidol it is important to appreciate that s uch symptoms usually resolve of their own accord.