Syringomyelia caused by intrathecal remnants of oil-based contrast medium

Case report

Mayumi Kubota M.D.1, Masahiro Shin M.D., Ph.D.2, Makoto Taniguchi M.D., Ph.D.1, Toru Terao M.D., Ph.D.1, Jun Nakauchi M.D., Ph.D.1, and Hiroshi Takahashi M.D., Ph.D.1
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  • 1 Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital; and
  • | 2 Department of Neurosurgery, University of Tokyo Hostpital, Tokyo, Japan
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✓ Oily contrast medium had been in use since the early 19th century as a radiographic agent for detecting spinal lesions and spinal cord tumors until the late 20th century. At that point computed tomography scanning and magnetic resonance imaging, or other hydrophilic contrast medium substituted for it. Adverse effects of oil-based dye, both acute and chronic, had been reported since the middle of the 20th century. In this paper the authors report the case of syringomyelia that seemed to be caused mainly by remaining oily contrast medium for 44 years.

Syringomyelia secondary to adhesive arachnoiditis caused by oily contrast medium after a long period of time is well known. In the present case, however, surgery revealed only mild arachnoiditis at the level of syringomyelia as well as both solid and liquid remnants of contrast medium.

Generally, cerebrospinal fluid (CSF) blockage due to an arachnoid adhesion is considered to cause syringomyelia following adhesive arachnoiditis. The authors speculated that in the present case syringomyelia was induced by a mechanism different from that in the previously reported cases; the oily contrast medium itself seems to have induced the functional block of CSF and impaired the buffer system of the intrathecal pressure. No reports on thoracic adhesive arachnoiditis and syringomyelia caused by oil-based dye referred to this mechanism in reviewing the literature.

Abbreviations used in this paper:

CSF = cerebrospinal fluid; MR = magnetic resonance.

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  • 1

    Barsoum AH, & Cannillo KL: Thoracic constrictive arachnoiditis after Pantopaque myelography: report of two cases. Neurosurgery 6:314316, 1980

    • Search Google Scholar
    • Export Citation
  • 2

    Bergeron RT, , Rumbaugh CL, , Fang H, & Cravioto H: Experimental pantopaque arachnoiditis in the monkey. Radiology 99:95101, 1971

  • 3

    Caplan LR, , Norohna AB, & Amico LL: Syringomyelia and arachnoiditis. J Neurol Neurosurg Psychiatry 53:106113, 1990

  • 4

    Chang HS, & Nakagawa H: Theoretical analysis of the pathophysiology of syringomyelia associated with adhesive arachnoiditis. J Neurol Neurosurg Psychiatry 75:754757, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Davies FL: Effect of unabsorbed radiographic contrast media on the central nervous system. Lancet 2:747748, 1946

  • 6

    Gnanalingham KK, , Joshi SM, & Sabin I: Thoracic arachnoiditis, arachnoid cyst and syrinx formation secondary to myelography with Myodil, 30 years previously. Eur Spine J 15:5 Suppl 661663, 2006

    • Search Google Scholar
    • Export Citation
  • 7

    Hill CA, , Hunter JV, , Moseley IF, & Kendall BE: Does myodil introduced for ventriculography lead to symptomatic lumbar arachnoiditis?. Br J Radiol 65:11051107, 1992

    • Search Google Scholar
    • Export Citation
  • 8

    Howland WJ, & Curry JL: Experimental studies of pantopaque arachnoiditis. I. Animal studies. Radiology 87:253257, 1966

  • 9

    Howland WJ, , Curry JL, & Bell RO: Experimental studies of pantopaque arachnoiditis. II. Laboratory studies. Radiology 87:257258, 1966

  • 10

    Howland WJ, , Curry JL, & Richey D: Experimental studies of pantopaque arachnoiditis. 3. Clinical studies in progress. Radiology 87:258261, 1966

    • Search Google Scholar
    • Export Citation
  • 11

    Koyanagi I, , Iwasaki Y, , Hida K, & Houkin K: Clinical features and pathomechanism of syringomyelia associated with spinal arachnoiditis. Surg Neurol 63:350356, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Lichtenstein RS: Arachnoiditis following myelography. Spine 4:9394, 1979

  • 13

    Milhorat TH, , Capocelli AL Jr, , Anzil AP, , Kotzen RM, & Milhorat RH: Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg 82:802812, 1995

    • Search Google Scholar
    • Export Citation
  • 14

    Noto GG: Arachnoiditis following myelography with iodized oil in lumbosacral disk herniation. Riv Patol Nerv Ment 74:166167, 1953

  • 15

    Ohata K, , Gotoh T, , Matsusaka Y, , Morino M, , Tsuyuguchi N, & Sheikh B, et al.: Surgical management of syringomyelia associated with spinal adhesive arachnoiditis. J Clin Neurosci 8:4042, 2001

    • Search Google Scholar
    • Export Citation
  • 16

    Park YK, & Tator CH: Prevention of arachnoiditis and postoperative tethering of the spinal cord with Gore-Tex surgical membrane: an experimental study with rats. Neurosurgery 42:813824, 1998

    • Search Google Scholar
    • Export Citation
  • 17

    Ramsey GHS, & Strain WE: Pantopaque: new contrast medium for myelography. Radiol & Clin Photog 20:25, 1944

  • 18

    Sander B, , Henkes H, , Lutz N, & Felix R: [The effect of x-ray contrast media on magnetic resonance tomography of the spinal canal.]. Rontgenblatter 42:343345, 1989. (Ger)

    • Search Google Scholar
    • Export Citation
  • 19

    Shah J, , Patkar D, , Parmar H, , Prasad S, & Varma R: Arachnoiditis associated with arachnoid cyst formation and cord tethering following myelography: magnetic resonance features. Australas Radiol 45:236239, 2001

    • Search Google Scholar
    • Export Citation
  • 20

    Shapiro R: Myelography ed 4 Chicago, Year Book, 1984. 13

  • 21

    Silva JA, , Taricco MA, , Brito JC, , Neves VD, & Farias RL: [Constrictive arachnoiditis after pantopaque myelography causing syringomyelia and paraparesis: case report.]. Arq Neuropsiquiatr 59:619622, 2001. (Port)

    • Search Google Scholar
    • Export Citation
  • 22

    Skalpe IO: Adhesive arachnoiditis following lumbar myelography. Spine 3:6164, 1978

  • 23

    Stoodley MA, , Jones NR, , Yang L, & Brown CJ: Mechanisms underlying the formation and enlargement of noncommunicating syringomyelia: experimental studies. Neurosurg Focus 8:3 E2, 2000

    • Search Google Scholar
    • Export Citation
  • 24

    Ward W, , Matheson M, & Gonski A: Three cases of granulomatous arachnoiditis after myelography. Med J Aust 2:333335, 1976

  • 25

    Wicke L, , Frühwald F, , Neuhold A, & Schwaighofer B: [MR effects of x-ray contrast media.]. Rofo 147:663665, 1987. (Ger)

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