1/7. Cerebral thrombophlebitis in three patients with probable multiple sclerosis. Role of lumbar puncture or intravenous corticosteroid treatment.We report 3 cases of young patients, 2 women and 1 man, who presented a cerebral venous thrombosis following intravenous treatment with high doses of corticosteroids. All of them presented a probable multiple sclerosis according to clinical, biological (CSF) and MRI criteria and were treated for the first time by a bolus of 1,000 mg of methylprednisolone OD during 5 days. All the usual causes of cerebral venous thrombosis were systematically excluded in all of them. The role of corticosteroid treatment in cerebral thrombophlebitis is discussed. All of them underwent a lumbar puncture a few days before corticosteroid treatment and the relationship between lumbar puncture and cerebral thrombophlebitis is also discussed. Cerebral venous thrombosis associated with corticosteroid treatment has rarely been reported. The relationship between corticosteroids and venous thrombosis has already been suggested but has never been clearly understood.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/7. Changing pattern of headache pointing to cerebral venous thrombosis after lumbar puncture and intravenous high-dose corticosteroids.OBJECTIVE: To emphasize the diagnostic importance of change in the headache pattern which pointed to cerebral venous thrombosis in two patients after lumbar puncture and high-dose intravenous methylprednisolone for suspected multiple sclerosis. RESULTS: Both patients had a diagnostic lumbar puncture for suspected multiple sclerosis and were treated with high-dose intravenous methylprednisolone. Both developed a postlumbar puncture headache that was initially postural, typical of low cerebrospinal fluid pressure. Three days later, the headache became constant, lost its postural component, and was associated with bilateral papilledema. magnetic resonance imaging of the brain disclosed superior sagittal and lateral sinuses thrombosis. The diagnostic difficulties of such cases and the potential role of lumbar puncture and corticosteroids as risk factors for cerebral venous thrombosis are discussed. CONCLUSIONS: When a typical postdural puncture headache loses its postural component, investigations should be performed to rule out cerebral venous thrombosis, particularly in the presence of other risk factors.- - - - - - - - - - ranking = 1.5keywords = puncture (Clic here for more details about this article) |
3/7. Life-threatening intracranial hypotension after diagnostic lumbar puncture.intracranial hypotension syndrome as a complication of diagnostic lumbar puncture is a rarely observed entity. intracranial hypotension syndrome is characterized by postural headache, neck pain/stiffness, blurred vision, nausea, vomiting, clouding of consciousness, dizziness and vertigo. The majority of cases resolve spontaneously with conservative treatment. Rarely, epidural blood patch is required. We report a 41-year-old man with multiple sclerosis, who developed intracranial hypotension syndrome after diagnostic lumbar puncture and who did not respond to conservative treatment. A subdural hematoma was subsequently found, when the patient showed considerable worsening of clinical conditions with life-threatening symptoms. Surgical evacuation of the subdural hematoma was not sufficient to improve significantly the patient's conditions, while complete symptoms remission was achieved 12 hours after epidural blood patch. We stress the need for epidural blood patch in any case of post-diagnostic lumbar puncture postural headache which does not resolve with conservative therapy.- - - - - - - - - - ranking = 1.1666666666667keywords = puncture (Clic here for more details about this article) |
4/7. Cerebral venous thrombosis in four patients with multiple sclerosis.We report four new cases of cerebral venous thrombosis (CVT) occurring in patients with multiple sclerosis (MS). Each patient had undergone lumbar puncture at varying times prior to clinical presentation (4 days to over 1 year). Only two of the patients had received intravenous (i.v.) methylprednisolone 48 h prior to CVT and were under oral contraception, a risk factor for cerebral thrombophlebitis. The other two patients had not undergone recent lumbar puncture, were not taking corticosteroids and did not present vascular risk factors. The patients all had normal routine blood work-ups and none had thrombophilia. All patients dramatically improved with full systemic heparinization. Minor sequelae were noticed in two patients. The pathogenesis underlying the occurrence of CVT in MS patients remains unclear and we discuss the relationship between lumbar puncture, steroid treatment and CVT.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
5/7. Cerebral venous thrombosis and demyelinating diseases: report of a case in a clinically isolated syndrome suggestive of multiple sclerosis onset and review of the literature.Cerebral venous thrombosis (CVT) has been described in several cases of clinically definite multiple sclerosis (MS). In the majority of these, lumbar puncture followed by intravenous corticosteroid treatment was suspected as the cause. We report what is, to our knowledge, the first case of a patient with a multifocal clinically isolated syndrome suggestive of MS onset, who developed multiple CVT after lumbar puncture and during high-dose i.v. corticosteroid treatment We conclude that the sequence 'lumbar puncture followed by corticosteroid treatment' may be a contributory risk factor for the development of CVT when associated with other risk factors.- - - - - - - - - - ranking = 0.5keywords = puncture (Clic here for more details about this article) |
6/7. Complementary and alternative therapies: the nurse's role.One objective of Healthy People 2010 is to increase both quality and years of healthy life. Complementary and alternative medicine (CAM) encompasses strategies that can help individuals meet this goal. CAM includes therapies such as acupuncture, dietary supplements, reflexology, yoga, massage, chiropractic services, Reiki, and aromatherapy. Many CAM therapies focus on the concept of energy. The literature describes the use of CAM in individuals with neurological diseases such as dementias, multiple sclerosis, neuropathies, spinal cord injury, and epilepsy. nurses have a unique opportunity to provide services that facilitate wholeness. They need to understand all aspects of CAM, including costs, patient knowledge, and drug interactions, if they are to promote holistic strategies for patients seeking to achieve a higher quality of life.- - - - - - - - - - ranking = 0.16666666666667keywords = puncture (Clic here for more details about this article) |
7/7. Apoplectic headache and oculomotor nerve palsy: an unusual presentation of multiple sclerosis.A patient with a history of facial myokymia presented with apoplectic headache and a 3rd nerve palsy. Initial CT, lumbar puncture, and cerebral angiogram were unremarkable, but subsequent CSF examination revealed oligoclonal bands. MRI displayed over 30 white matter lesions. This case demonstrates that multiple sclerosis may present with severe headache and a 3rd nerve palsy, simulating the clinical picture of a posterior communicating artery aneurysm.- - - - - - - - - - ranking = 0.16666666666667keywords = puncture (Clic here for more details about this article) |