1/4. Dural puncture and corticotherapy as risks factors for cerebral venous sinus thrombosis.Dural puncture with corticosteroid could be a predisposing factor for cerebral venous thrombosis (CVT). A 35-year-old woman using oral contraception was treated with corticosteroid epidural infiltration for L5 radiculalgia. The following day a postural headache developed and accidental dural puncture was suspected. Four days later, she presented with fever and consciousness impairment requiring mechanical ventilation. magnetic resonance angiography (MRA) confirmed thrombosis of the superior sagittal sinus. Recanalization was observed three weeks later and the patient fully recovered. blood tests for thrombophilia showed a moderate decrease in the C protein level (chronometric activity 44%, N = 65-130). CVT has been reported after spinal anaesthesia or peridural anaesthesia with accidental puncture. After dural puncture the decrease of cerebrospinal fluid pressure induces a rostrocaudal sagging effect with traumatic damage to the fragile venous endothelial wall, and may trigger a venous vasodilatation with resultant stasis. CVT has also been described in patients after lumbar puncture and oral corticoid treatment for multiple sclerosis and after corticosteroid intrathecal infiltration. Therefore, corticosteroids can be considered as a potential additional procoagulant stimuli.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
2/4. amyotrophic lateral sclerosis and parkinsonian syndromes in high incidence among the Auyu and Jakai people of West new guinea.amyotrophic lateral sclerosis (ALS) and parkinsonism-dementia (PD) occur in the highest recorded incidence among primitive Auyu and Jakai people on the southern coastal plain of West new guinea, in association with a heretofore unrecognized subacute, often recurrent, paralytic "poliomyeloradiculitis" (PMR). Ninety-seven cases of ALS, 19 cases of PD and 18 cases of PMR were recorded, with mean ages of onset of 33, 43, and 26, respectively, in a small affected population of only about 7000. The ecology, culture, and diet of the remote, primitive ALS- and PD-affected people are indistinguishable from that of their unaffected neighbors, except for a remarkable deficiency of calcium and magnesium in their soil and drinking water. The distribution of affected and nonaffected villages indicates that communicable infectious or genetic etiology is unlikely. As a result of the isolation and primitive technology, domestic animals (except dogs and pigs) were not found among the Auyu and Jakai, and no manufactured products (including metals, ceramics, textiles, petrochemicals, medicines, food additives, condiments, paints, dyes, or solvents) were available to them.- - - - - - - - - - ranking = 5keywords = sclerosis (Clic here for more details about this article) |
3/4. Acute urinary retention due to sacral myeloradiculitis.Three cases of acute urinary retention without local urological causes are described. A diagnosis of sacral myeloradiculitis of viral origin appeared more likely than a first episode of multiple sclerosis. The literature is reviewed and a protocol for the investigation of such patients is suggested.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
4/4. Thoracic radicular symptoms in amyotrophic lateral sclerosis.We report 4 patients with amyotrophic lateral sclerosis (ALS) complaining of thoracic radicular symptoms. We postulate that in some patients paraspinal muscle weakness can result in an increased thoracic kyphosis, possibly producing traction on the thoracic roots.- - - - - - - - - - ranking = 5keywords = sclerosis (Clic here for more details about this article) |