Retrospective Study

Incidence of seizures associated with iopamidol or

iomeprol myelography in dogs with intervertebral
disk disease: 161cases (2000^2002)
Leona Lexmaulova, MVDr; Josef Zatloukal, MVDr, PhD; Pavel Proks, MVDr; Milan Dvorak, MVDr,
PhD; Robert Srnec, MVDr; Petr Rauser, MVDr, PhD; Helga Kecova, MVDr, PhD and Alois Necas,
MVDr, PhD, MBA
Abstract
Objective To compare the incidence of seizures in dogs with intervertebral disk disease after iopamidol or
iomeprol myelography, and to assess whether the incidence of seizures differed between the 2 agents when
severity of neurological decits, location of cord compression, duration of anesthesia, site of myelogram,
volume of contrast, and concentration of contrast were evaluated.
Design Retrospective study.
Setting Veterinary teaching hospital.
Animals One hundred and sixty-one client-owned dogs with intervertebral disk disease.
Interventions Subarachnoid injection of contrast medium.
Measurements and Main Results One hundred and sixty-one dogs with intervertebral disk disease were
subjected to myelography using iopamidol (n574) or iomeprol (n587). Cranial myelography was performed
in 31 dogs, caudal myelography in 125 and both cranial and caudal myelography in 5. Seizures occurred in 23
of 161 (14%) dogs. There was no signicant difference overall between iopamidol and iomeprol myelography.
However, in dogs with thoracolumbar disk extrusion and paraplegia, seizures occurred more frequently after
caudal myelography using iopamidol compared with iomeprol.
Conclusions Both iomeprol and iopamidol are suitable for myelography in dogs. Iomeprol is recommended
for caudal myelography in paraplegic dogs with thoracolumbar disk extrusion due to the higher incidence of
seizures in this group when iopamidol was used.
(J Vet Emerg Crit Care 2009; 19(6): 611616) doi: 10.1111/j.1476-4431.2009.00479.x
Keywords: contrast radiography, diagnostic imaging, spinal cord
Introduction
Myelography is the most common diagnostic imaging
method used in veterinary practice to determine the
location and extent of spinal cord disease.
1
It is an in-
vasive method of contrast radiography involving injec-
tion of contrast medium into the spinal subarachnoid
space under general anesthesia. Possible complications
of the procedure include neurologic signs ranging from
muscle fasciculations to generalized seizures, exacer-
bation of the patients neurologic condition, and vom-
iting.
2
The incidence of seizures depends on lesion
location,
3,4
severity of neurologic decit,
5
type of myelo-
graphy (location, contrast medium, volume, concentra-
tion, and number of injections of contrast medium),
3,58
as well as type and duration of anesthesia.
7
Age, sex,
and weight can also inuence the incidence of seizures.
4
Iopamidol and iomeprol are nonionic contrast media
that have a relatively low risk of adverse effects.
2,8
They
can be safely used in dogs even at higher concentra-
tions.
9
Iopamidol was shown to have minimal neuro-
toxicologic effects on the leptomeninges.
10
Iomeprol is
stated to be nonepileptogenic, and its acute toxicity is
comparable to that of iopamidol.
1114
Nonionic contrast
media may be used at higher concentrations in dogs to
The authors declare no conicts of interest.
Address correspondence and reprint requests to
Dr. Leona Rauserova, Department of Surgery and Orthopedics, Small
Animal Clinic, University of Veterinary and Pharmaceutical Sciences,
Palackeho 13, 612 42 Brno, Czech Republic.
Email: rauseroval@vfu.cz
From the Department of Surgery and Orthopedics (Lexmaulova, Dvorak,
Srnec, Rauser, Kecova, Necas) and the Department of Diagnostic Imaging,
Small Animal Clinic, University of Veterinary and Pharmaceutical Sciences,
Brno, Czech Republic (Zatloukal, Proks).
Journal of Veterinary Emergency and Critical Care 19(6) 2009, pp 611616
doi:10.1111/j.1476-4431.2009.00479.x
& Veterinary Emergency and Critical Care Society 2009 611
obtain better myelograms.
15
The use of contrast media
with a higher iodine concentration enhances the quality
of the image of spinal cord contours; however, this is
limited by a higher risk of adverse effects induced by
hyperosmolarity.
6,7
The ideal contrast medium would be radiopaque,
nontoxic, miscible with cerebrospinal uid (CSF), iso-
tonic, and pharmacologically inert.
15
Iopamidol and io-
meprol are iodine-based, nonionic and water-soluble
compounds with a low osmolality. These agents are not
metabolized and are secreted unchanged through the
kidneys.
12,14
Commercial preparations are available
at various iodine concentrations (iopamidol 200, 300,
and 400 mgiodine/mL; iomeprol 150, 200, 250, 300,
and 400 mgiodine/mL). Some authors
7,16
consider
300 mgiodine/mL an ideal concentration, in terms of
balancing the quality of a myelogram with the risk of
possible adverse effects. Widmer and Blevins
9
reported
that the most suitable concentration of iodine was
200 mgiodine/mL. Fatone et al
15
reported better con-
trast imaging of the spinal cord (without a signicant
increase in adverse effects) after injection of a contrast
agent at concentrations of 350370mgiodine/mL.
The risk of seizures after myelography is reduced
further, by proper anesthesia.
17
The anesthetic protocol
should minimize the risk of seizures and other possible
complications (changes in respiratory and heart rate,
cardiac arrhythmias) after subarachnoid application of
contrast medium. Close attention should be paid to
appropriate perioperative pain management and ade-
quate spontaneous ventilation.
6,1823
The aims of this study were (1) to compare the in-
cidence of seizures as a complication of myelography in
dogs with compressive lesions of the spinal cord caused
by intervertebral disk disease (IVDD) following the use
iopamidol and iomeprol; and (2) to assess whether the
incidence of seizures differed between the 2 agents
when severity of neurologic decits, location of cord
compression, duration of anesthesia, site of myelogram,
volume of contrast, and concentration of contrast were
evaluated.
Materials and Methods
The medical records of our clinic were reviewed to nd
dogs that were presented between January 2000 and
December 2002 with signs of neurologic decit. The
inclusion criteria for the study were a diagnosis of
IVDD combined with surgical treatment. Patients with
history of seizures, organ dysfunctions, general neuro-
logic disorders, or mild degree of neurologic decit
were excluded. Preoperative workup included com-
plete physical and neurologic exam, and hematology
and serum biochemistry prole. Neurologic decits
were scored on a scale of IIII (cervical spinal cord le-
sions) and IIV (thoracolumbar spinal cord lesions) ac-
cording to severity.
5
After the neurologic examination, all dogs underwent
general anesthesia, survey radiography, and myelo-
graphy. Patients were premedicated with medetomidine
a
(0.02 mg/kg, IV) and buprenorphine
b
(0.01 mg/kg, IV)
and anesthesia was induced with propofol
c
(1 mg/kg, IV)
and maintained
d
by inhalation of isourane
e
in 100%
oxygen.
Based on the clinical lesion localization, cranial, cau-
dal, or combined cranial and caudal myelography were
performed using standard techniques.
17,24
Percutane-
ous puncture was performed using a 22-Ga spinal nee-
dle.
f
Before injection of the contrast agent, a sample of
CSF was obtained for cytologic and biochemical anal-
ysis.
24
Needle placement within the subarachnoid
space was conrmed either clinically by visualization
of CSF backow into the needle hub or by uoroscopy
after injection of a small volume of contrast medium.
Before injection, the contrast medium was preheated
to 381C and then injected very slowly over 2 minutes.
After the procedure, the patients were placed on an
inclined mat to facilitate ow of contrast to the site of
the lesion.
24
Lateral, ventrodorsal, and 2 oblique (451) ventrodor-
sal radiographs were taken of the spinal segment of
interest, to determine the location and character of
the spinal lesions.
24
Ventral slot decompression and
removal of extruded disk fragments from the extra-
dural space
8
were performed in patients with cervical
spinal lesions. Thoracolumbar lesions were managed
by hemilaminectomy.
8,25,26
Myelography and surgical
procedures were performed under standard conditions
(lege artis) by 2 specialists. All patients were moni-
tored for the occurrence of seizures for 24 hours after
myelography.
Seizures were dened as episodes characterized by
presence of any of the following: excessive salivation,
chewing movements, rigid extension of the limbs,
clonic limb activity or paddling, uncontrollable jerking
of the head and trunk, or urinary or fecal incontinence.
4
Statistical methods
Iopamidol and iomeprol were compared for incidence
of seizures using the w
2
-test. Groups with low incidence
were compared by Fishers exact test. Multivariate an-
alyses were performed for the following variables: lo-
cation of spinal compression, severity of neurologic
decits, myelography site, concentration, and volume
of contrast medium, and duration of anesthesia. These
were compared between dogs that did and did not de-
velop seizures. Signicance was set at Po0.05.
& Veterinary Emergency and Critical Care Society 2009, doi: 10.1111/j.1476-4431.2009.00479.x 612
L. Rauserova et al.
Results
Over the study period from January 2000 to December
2002, 556 dogs with neurologic decits were presented
to the clinic, and of these 161 dogs met the inclusion
criteria for the study. Of the 161 dogs studied, 94 were
male and 67 were female. Twenty-three breeds were
represented. The median age was 7.2 years (range,
1.512 y); median weight was 10.65 kg (range, 2.644).
Eighteen of 161 patients (11%) had motor decits of the
thoracic limbs and 143 of 161 (89%) had decits of the
pelvic limbs. All patients from our study group had
intervertebral disk protrusion/extrusion located in the
cervical or thoracolumbar spinal cord area. The preop-
erative laboratory ndings were not clinically signi-
cant in any of the dogs. Surgery was performed
immediately following myelography in dogs with thor-
acolumbar compression, and at a later stage in dogs
with cervical compression.
Anesthesia was uneventful in all cases and vital func-
tions were monitored
g
throughout. During anesthesia
and in the recovery phase, lactated Ringers solution
was administered at a rate of 10 mL/kg/h. Duration of
anesthesia from administration of contrast medium to
recovery ranged from 40 to 120 minutes (mean 93 min).
Thirty-one of 161 dogs (19%) were subjected to cra-
nial myelography, 125 of 161 (78%) to caudal myelo-
graphy, and 5 of 161 (3%) to combined cranial and
caudal myelography.
The CSF protein was elevated in 33 of 161 patients
(20%). There were no pathologic changes on cytologic
analysis of CSF in any patient.
Iopamidol
h
was injected at concentrations of 200 or
300 mg iodine/mL and iomeprol
i
at 250 or 300 mg io-
dine/mL. Volumes ranged from 0.2 to 0.54 mL/kg.
Seventy-four dogs received iopamidol for myelography
and 87 received iomeprol. Twenty of 161 dogs (23%)
received 0.20.3 mL/kg of contrast medium, 102 of 161
(63%) dogs received 0.30.5 mL/kg, and 39 of 161 (24%)
dogs received 40.5 mL/kg (Table 1).
Eighteen of 161 dogs (11%) had cervical spinal lesions
and 143 of 161 (89%) had thoracolumbar lesions. The
143 dogs with thoracolumbar lesions had surgery im-
mediately after the myelogram. Surgery was not per-
formed immediately in the dogs with cervical lesions,
which were allowed to recover from anesthesia after
the myelogram.
Seizures occurred in 23 of 161 dogs (14%). Four of the
18 (22%) dogs with cervical lesions seizured, compared
with 19 of 143 (13%) of those with thoracolumbar lesions
(Figure 1). There was no signicant difference overall
between iopamidol (seizures in 14 of 74 dogs; 19%) and
iomeprol (seizures in 9 of 87 dogs; 10%), when factors
other than myelography type and location of spinal cord
compression lesion were considered (P40.05) (Figure 1).
However, statistically signicant differences were
found between the contrast agents when dogs were
grouped according to localization of the lesion and se-
verity of the neurologic decit. Paraplegic dogs with
compression lesions in the thoracolumbar area had a
signicantly higher incidence of seizures after iopam-
idol compared with iomeprol: 12 of 51 dogs (24%) ver-
sus 5 of 55 dogs (9%), respectively (P50.04) (Figure 2).
In paraplegic dogs that received iopamidol, there
was a higher incidence of seizures (P50.04) after cau-
dal myelography (12/51 [24%]), especially at the higher
concentration of iodine (iopamidol 300 mgiodine/mL)
(7/29 [24%]) (P50.01) (Figure 3).
If compression was located in the cervical area, no
signicant difference was found between iopamidol
(2/6 [33%]) and iomeprol (2/12 [17%]) (Figure 1).
In paraplegic patients with duration of anesthesia
longer than 90 minutes (106 patients), there was a sig-
nicantly higher incidence of seizures after iopamidol
(12/51 [24%]) than iomeprol (5/55 [9%]) (P50.04)
(Figure 4). Signicant differences were not detected
based on volume of contrast medium, age, sex, or
weight of dogs.
Discussion
This retrospective study identied a signicantly higher
incidence of seizures after subarachnoid iopamidol
Table1: Incidence of seizures in relation to the myelography technique and the type and volume of contrast medium administered
Contrast
agent
Volume
(mL/kg)
Cranial
myelography
Caudal
myelography
Cranial and caudal
myelography
Seizures No seizures Total Seizures No seizures Total Seizures No seizures Total
Iopamidol 0.20.3 0 2 2 0 8 8 0 0 0
0.30.5 2 3 5 5 29 34 1 0 1
40.5 1 0 1 5 17 22 0 1 1
Iomeprol 0.20.3 3 4 7 0 2 2 0 1 1
0.30.5 2 12 14 4 43 47 0 1 1
40.5 0 2 2 0 12 12 0 1 1
& Veterinary Emergency and Critical Care Society 2009, doi: 10.1111/j.1476-4431.2009.00479.x 613
Seizures after iopamidol or iomeprol myelography in dogs
injection in paraplegic dogs with thoracolumbar lesions
that had been subjected to caudal myelography and
had longer duration of anesthesia.
In this group of patients there was also a signicantly
higher incidence of seizures after the use of iopamidol
at a concentration of 300 mg iodine/mL. The higher in-
cidence of seizures in these patients could be explained
by the fact that during caudal myelography the contrast
material proceeds cranially. Both, volume of contrast
medium injected and disturbed CSF ow due to the
compressive lesion, can result in increased intracranial
pressure.
3,27
These ndings might also be the result of slower ex-
cretion of iopamidol from the subarachnoid space com-
pared with iomeprol.
12,13,28
In addition, dogs with
paraplegia are prone to dehydration as they usually
cannot urinate spontaneously and may drink smaller
amounts. This could lead to slower elimination of con-
trast media from the subarachnoid space and increased
incidence of seizures.
11,17
We strove to eliminate this
factor by uid therapy (based on the clinical signs of
hydratation status).
29
The higher incidence of seizures after injection of io-
pamidol at the higher iodine concentration could be
also explained by the negative effect of hyper-
osmolarity. Because the same anesthetic protocol was
used in all patients, the difference in incidence of sei-
zures with the longer duration of anesthesia was prob-
ably also related to faster elimination of iomeprol than
iopamidol from the subarachnoid space.
12
This nding
is consistent with the fact that no signicant difference
was found between the incidence of seizures after io-
pamidol versus iomeprol in patients with a shorter du-
ration of anesthesia. These patients had lesions in the
cervical area of the spinal cord, which in itself increases
risk of seizures.
4
In addition, where cranial myelo-
graphy was used the surgery did not immediately
follow the myelogram, and the duration of anesthesia
was shorter than in patients with thoracolumbar disk
extrusion.
1 1 1 1
2
3
4
9
0
1
2
3
4
5
6
7
8
9
10
Iopamidol
II
Iomeprol
II
Iopamidol
III
Iomeprol
III
n = 18
Cervical spinal cord lesion
Thoracolumbar spinal cord lesion
N
u
m
b
e
r

o
f

d
o
g
s
seizures
total
0
1
0
1
5
4
3
12
17
51
55
12*
0
10
20
30
40
50
60
Iopamidol
II
Iomeprol
II
Iopamidol
III
Iomeprol
III
Iopamidol
IV
Iomeprol
IV
n = 142
N
u
m
b
e
r

o
f

d
o
g
s
seizures
total
Figure2: Incidence of seizures between groups according to the
type of contrast medium, the location of compression, and the
degree of neurologic decit.
n
Signicantly higher incidence of
seizures (P50.04) with the use of iopamidol in dogs with de-
gree IV neurologic decits as compared with iomeprol.
5
3
1
22 22
29
33
7*
0
5
10
15
20
25
30
35
Iopamidol 200 Iomeprol 250 Iopamidol 300 Iomeprol 300
n = 106
N
u
m
b
e
r

o
f

d
o
g
s
seizures
total
Figure3: Incidence of seizures in dogs with thoracolumbar le-
sions between groups administered differing concentrations of
iodine.
n
Signicantly higher incidence of seizures (P50.01)
with use of iopamidol (300 mg iodine/mL) compared with the
same concentration of iomeprol.
0
2
4
8
10
12
N
u
m
b
e
r

o
f

d
o
g
s
6
2 2
6
10
Iopamidol Iomeprol
Cranial myelography
Cervical lesion, n = 16
seizure
total
Figure1: Incidence of seizures between groups according to the
type of the contrast medium, the location of its administration,
and localization of lesion.
& Veterinary Emergency and Critical Care Society 2009, doi: 10.1111/j.1476-4431.2009.00479.x 614
L. Rauserova et al.
The incidence of seizures was quite low and there
were no signicant differences between contrast media
for patients with lesions in the cervical spine. These
results correspond with studies performed in dogs
4,8,30
(frequency of seizures varies between 11% and 75%)
and men.
13
Careful and slow injection of contrast
medium into the cerebellomedullary cistern may help
explain the low incidence of seizures. Control radio-
graphic views showed that contrast medium did not
enter the cerebral ventricles. After application of con-
trast medium, the patients head was elevated to reduce
the risk of contrast medium owing cranially.
17
The absence of a statistically signicant difference
when comparing the overall incidence of seizures after
application of different volumes of iopamidol and io-
meprol was probably due to the low osmolality, water-
solubility, high neurotolerability, and low toxicity of
both media.
2,10,11
It is interesting to note that there was
a higher incidence of seizures after injection of smaller
volumes of iomeprol (up to 0.3 mL/kg, maximum
12 mL total volume) into the cerebellomedullary cis-
tern in dogs with paraplegia, compared with higher
volumes. However, this was not statistically signicant
compared with the same dose of iopamidol. This may
be explained by the increased risk of seizure activity
after cranial myelography due to impaired caudal
drainage of CSF in animals with severe compression
lesions, or an increase of intracranial pressure, or
both.
3,4,17
Our ndings are in agreement with those of
a retrospective study of iohexol myelography in 182
dogs where the dose of contrast medium was not cor-
related with seizure activity.
4
In contrast to the study of Barone et al,
4
that reported
a higher incidence of seizures in dogs weighing
420 kg, we did not nd a statistically signicant inu-
ence of body weight on the incidence of seizures after
iopamidol or iomeprol myelography. This could be due
to the low number of dogs weighing 420 kg (5 of 161)
in our study.
Our study has several limitations. In some groups
there were low number of patients, making meaningful
statistical comparison difcult or impossible to evalu-
ate. We did not compare incidence of seizures in ani-
mals with preexisting seizure disorders, which is an
area for future study.
In conclusion, although small, the present study
shows that the overall incidence of seizures was similar
for iopamidol and iomeprol. However, statistically sig-
nicant differences were found in paraplegic dogs with
IVDD localized to the thoracolumbar spinal cord area,
in which there was a higher incidence of seizures after
caudal myelography with the use of iopamidol and a
longer duration of anesthesia. The results suggest that
in this patient group, it is preferable to perform myelo-
graphy by administering iomeprol via the L5-L6 inter-
vertebral space rather than iopamidol, in order to
minimize the risk of seizures.
From a clinical point of view, it is important to note
that both iopamidol and iomeprol are relatively safe for
myelography in dogs with IVDD. The overall incidence
of seizures was quite low. Therefore, both contrast me-
dia are suitable for myelography in dogs.
Acknowledgements
The authors thank Susan B. Robbins, Katarina Brezna,
Vladimir Jekl, Radka, and Zdenek Andysik for techni-
cal support.
Footnotes
a
Domitor, Orion Corporation, Espoo, Finland.
b
Temgesic, Reckitt and Colman Prod. Ltd, Hull, UK.
c
Propofol 1%, Fresenius Kabi, Graz, Austria.
d
Anemat N8, Chirana, Stara Tura, Slovak Republic.
e
Forane, Aesica Queenborough Ltd, Queenborough, UK.
f
Spinocan, B.Braun, S.A., Sao Goncalo, Brazil.
g
Datex Cardiocap II, Datex-Ohmeda, Helsinki, Finland.
h
Iopamiro, Bracco S.p.A., Milano, Italy.
i
Iomeron, Bracco S.p.A.
References
1. Kirberger RM, Roos CJ, Lubbe AM. The radiological diagnosis of
thoracolumbar disc disease in the dachshund. Vet Radiol Ultra-
sound 1992; 33(5):255261.
2. Wheeler SJ, Davies JV. Iohexol myelography in dog and cat: a
series of one hundred cases, and a comparison with metrizamide
and iopamidol. J Small Anim Pract 1985; 26(5):247256.
3. Adams WM, Stowater JL. Complications of metrizamide myelo-
graphy in the dog: a summary of 107 clinical case histories. Vet
Radiol Ultrasound 1981; 22(1):2734.
4. Barone G, Ziemer LS, Shofer FS, et al. Risk factors associated with
development of seizures after use of iohexol for myelography in
4
51
55
12*
0
10
20
30
40
50
60
Iopamidol Iomeprol
anesthesia >90 min, n = 106
N
u
m
b
e
r

o
f

d
o
g
s
seizures
total
Figure4: Incidence of seizures in dogs with thoracolumbar
lesions according to the type of contrast medium and duration
of anesthesia (490 min).
n
Signicantly higher incidence of sei-
zures (P50.04) with use of iopamidol in comparison with
iomeprol.
& Veterinary Emergency and Critical Care Society 2009, doi: 10.1111/j.1476-4431.2009.00479.x 615
Seizures after iopamidol or iomeprol myelography in dogs
dogs: 182 cases (1998). J Am Vet Med Assoc 2002; 220(10):1499
1502.
5. Toombs JP, Bauer MS. Intervertebral disc disease, In: Slatter D. ed.
Textbook of Small Animal Surgery, 2nd ed. Philadelphia: WB
Saunders; 1993, pp. 10701087.
6. Cox F, Jakovljevic S. The use of iopamidol in myelography in dogs. A
study of twenty-seven cases.. J Small Anim Pract 1986; 27(3):159165.
7. Widmer WR. Iohexol and iopamidol: new contrast media for vet-
erinary myelography. J Am Vet Med Assoc 1989; 194(12):17141716.
8. Widmer WR, Blevins WE, Jakovljevic S, et al. Iohexol and iopam-
idol myelography in the dog: a clinical trial comparing adverse
effects and myelographic quality. Vet Radiol Ultrasound 1992;
33(6):327333.
9. Widmer WR, Blevins WE. Veterinary myelography: a review of
contrast media, adverse effects, and technique. J Am Anim Hosp
Assoc 1991; 27(2):163177.
10. Spencer CP, Chrisman CL, Mayhew IG, et al. Neurotoxicologic
effects of the nonionic contrast agent iopamidol on the leptome-
ninges of the dog. Am J Vet Res 1982; 43(11):19581962.
11. La Noce A, Bertani F, Lorusso V, et al. Preclinical safety assessment
of iomeprol for injection as contrast medium for myelography. Eur
J Radiol 1994; 18(1):S43S50.
12. Katayama H, Heneine N, van Gessel R, et al. Clinical experience
with iomeprol in myelography and myelo-CT: clinical pharma-
cology and double-blind comparisons with iopamidol, iohexol,
and iotrolan. Invest Radiol 2001; 36(1):2232.
13. Katayama H, Spinazzi A, Fouillet X, et al. Iomeprol: current and
future prole of a radiocontrast agent. Invest Radiol 2001; 36(2):8796.
14. Frigeni V, Samuelli G, Miragoli L, et al. Effect of iomeprol on rat
hippocampal slice synaptic transmission: comparison with other
X-ray contrast agents. Invest Radiol 2002; 37(4):222231.
15. Fatone G, Lamaga F, Pasolini MP, et al. Myelography in the dog
with non-ionic contrast media at different iodine concentrations.
J Small Anim Pract 1997; 38(7):292294.
16. Herrtage ME, Dennis R. Contrast media and their use in small
animal radiology. J Small Anim Pract 1987; 28(12):11051114.
17. Roberts ER, Selcer BA. Myelography and epidurography. Vet Clin
North Am Small Anim Pract 1993; 23(2):307329.
18. Harvey RC, Sims MH, Greene SA. Neurologic disease, In: Thur-
non JC, Tranquilli WJ, Benson GJ. eds. Lumb & Jones Veterinary
Anesthesia, 3rd ed. Baltimore: Williams & Wilkins; 1996, pp. 775
785.
19. Sande RD. Radiography, myelography, computed tomography,
and magnetic resonance imaging of the spine. Vet Clin North Am
Small Anim Pract 1992; 22(4):811831.
20. Shores A, Burns J. Technique and indications for metrizamide
myelography in small animals. Compend Contin Educ Pract Vet
1987; 9(4):361364.
21. Blaze CHA, Glowaski MM. Veterinary Anesthesia Drug Quick
Reference. St Louis: Elsevier Saunders; 2004, pp. 1114.
22. Keegan RD, Greene SA, Bagley RS, et al. Effects of medetomidine
administration on intracranial pressure and cardiovascular vari-
ables of isourane-anesthetized dogs. Am J Vet Res 1995;
56(2):193198.
23. Reid J, Nolan AM. Intravenous anaesthetics, In: Seymour CH,
Gleed R. eds. Manual of Small Animal Anaesthesia and Analgesia.
Shurdington: BSAVA; 1999, pp. 8895.
24. Oliver JE, Hoerlein BF, Mayhew IG. Veterinary Neurology. Phil-
adelphia: W.B. Saunders; 1987, 554pp.
25. Necas A. Clinical aspects of surgical treatment of thoracolumbar
disc disease in dogs. A retrospective study of 300 cases. Acta Vet
Brno 1999; 68(2):121130.
26. Necas A. Rate of neurologic recovery as an indicator of long-term
prognosis in dogs with surgically treated thoracolumbar disc dis-
ease. Vet Med Czech 2000; 45(1):1924.
27. Lewis DD, Hosgood G. Complications associated with the use
of iohexol for myelography of the cervical vertebral column in
dogs: 66 cases (19881990). J Am Vet Med Assoc 1992; 200(9):1381
1384.
28. Duchin KL, Drayer BP, Ross M, et al. Pharmacokinetics of Iopam-
idol after intrathecal administration in humans. Am J Neuroradiol
1986; 7(5):895898.
29. Hughes D. Fluid therapy, In: King L, Hammond R. Manual of
Canine and Feline Emergency and Critical Care. Shurdington:
BSAVA; 1999, pp. 722.
& Veterinary Emergency and Critical Care Society 2009, doi: 10.1111/j.1476-4431.2009.00479.x 616
L. Rauserova et al.