growth characteristics in culture and is sensitive to
a
number of antibiotic agents. G. Franklin, MD Dept of Neurology Southwestern Med School Univ of Texas Health Science Center at Dallas Dallas, TX 75235
1. Jones HM: Cranial pneumatocoele. Proc R Soc Med 63:257-262, 1970. 2. French LA, Chou SN: Osteomyelitis of the skull and epidural abscess, in Gurdjian ES (ed): Cranial and Intracranial Suppuration. Springfield, Ill, Charles C Thomas Publisher, 1969, pp 59-72. 3. Handel SF, Kelin WC, Kimy YW: Intracranial epidural abscess. Radiology 111:117-120, 1974. 4. Dorff GJ, Jackson LJ, Rytel MW: Infections with Eikenella corrodens: A newly recognized human pathogen. Ann Intern Med 80:305-309, 1974. 5. Marsden HB, Hyde WA: Isolation of Bacteroides corrodens from infections in children. J Clin Pathol 24:117-119, 1971.
Arachnoiditis From Intrathecally Given Corticosteroids in the Treatment of Multiple Sclerosis To the Editor.\p=m-\Ina previous report,1 arachnoiditis and sterile meningitis were listed as serious side effects from methylprednisolone acetate given intrathecally to patients with acute-phase multiple sclerosis. In addition to the four previously reported patients with arachnoiditis, we have seen three others, bringing the total reported cases to seven. The following report is
typical. Report of a Case.\p=m-\Beginning36 years ago, a 53-year-old man developed retrobulbar neuritis, spasticity of the legs, paresthesia of the hands, and papillitis of the optic disks in exacerbations and remissions. Elsewhere, he was given a series of 16 intrathecal injections of methylprednisolone acetate (40 to 80 mg each) over a seven-year period. The spinal fluid protein content gradually
racic areas. They thesia of the legs
complaint might be related to the well-known elevation of spinal fluid protein and cell content following injections. Some investigators have found the protein and cell content to be directly related to the dosage of corticosteroid given. Patients with arachnoiditis thus far reported have shown a progression upward of spinal fluid protein level and a steady downhill course in leg strength and bladder function. This combination of events may well be a sign of arachnoiditis, and the harbinger of a complete spinal fluid block. The dangers of adhesive arachnoiditis and the findings of insignificant rates of improvement in several studies indicate little rationale for this mode of therapy in patients with multiple sclero¬ sis. D. Nelson, MD Wilmington Med Center Wilmington, DE 19899 1. Nelson
DA, Vates TS Jr, Thomas RB Jr: Complications from intrathecal steroid therapy in patients with multiple sclerosis. Acta Neurol Scand 49:176-188, 1973.
Platelet Hyperaggregability in Young Patients With Stroke To theEditor.\p=m-\The
interesting article by Kalendovsky et al, on platelet hyperaggregability in young patients with stroke, in the January 1975 issue of the Archives (32:13,1975) prompts me to make this report (March 1975) of results obtained from a pilot study conducted on 15 patients with stroke (mean age, 63 years) vs 15 control patients of the same age, 15 young asymptomatic persons (mean age, 25 years) and 15 other patients given anticoagulant therapy with warfarin sodium (Coumadin) (mean prothrombin time, 20.6 sec-
onds).
corticosteroids continue to be administered to many patients for the treatment of arachnoiditis following surgery for disk disease, and for the treatment of multiple sclerosis. The lack of complications reported in patients treated for disk complica¬ tions may be due to the difficulty of evaluating possible "new" arachnoiditis added to chronic arachnoiditis. Also, there may be a difference in the pathophysiology of arachnoiditis in patients with disk disease as compared to those with multiple sclerosis. Patients who are given methylprednisolone
intrathecally
prone to develop arachnoiditis in the upper lumbar and midthoacetate
seem
Downloaded From: http://archneur.jamanetwork.com/ by a University of Manitoba User on 06/18/2015
One of the coagulation tests performed was designed here. It consisted of drawing 10 ml of fresh venous blood, placing 0.5 ml in each of ten funnel-shaped glass tubes, then leaving it to clot. Exactly 15 and 30 minutes after the blood had been drawn, each set of five clot-containing glass tubes was subjected to a continuously increasing pressure induced by pumped isotonic saline, until the clots gave away. All pressures recorded from each set were averaged (we termed this test "mechanical clot resistance"). The results from this test (Figure) showed that the 15 stroke patients had a significantly higher mean clot resistance as compared to both control groups (P .01). Two other strokes due to hyper¬ tensive hemorrhage, one embolie case secondary to auricular fibrillation, and one stroke with simultaneous disseminated intravascular coagu¬ lation all showed "normal" or low mean values. The young control group demonstrated practi¬ cally the same mean values as those of the similar-age control group. But two young women had high values equivalent to those of the stroke group. Both of them suffered chronic migraine headaches. Using the aggregometer in vitro, the hyperaggregability of platelets showed no significant statistical differences between the various groups (16%). Diabetes (37%) and hyperlipidemias (types II and IV, 42%) were also not significantly different. On the other hand, hyper¬ tension (42%) and electrocardiographic evidence of previous myocardial infarction (28%) were both significantly different factors (P .05 and =
=
=
.025, respectively).
It is of interest to note that independent studies of cerebrovascular disease, using differ¬ ent coagulation indexes, have shown seemingly consistent abnormal results.14 This information is offered only to add further
Time sequence of mechanical clot resistance. Values
given
are mean
of each group.
450
increased from 82 to 159 mg/100 ml. He had subjective spasticity of the legs during a five\x=req-\ year period that necessitated hospitalization in 1974. A myelogram revealed multiple adhesions in the subarachnoid space at T-1 through T-4 and T-12 through L-2. Loculated iophendylate (Pantopaque) was trapped in these areas and did not move although the patient was placed in the sitting position for several hours. Surgery was not recommended1 because of the multiple levels of the lesions.
Comment.—Intrathecally given
frequently complain of pares¬ following such injections. This
411
261
Hypercoagulable Stroke Group Controls of Similar Age Young Controls
208 76 Warfarin Sodium Patients
200
8
10
12
18
20
22
24
26
28
30
a
number of antibiotic agents. G. Franklin, MD Dept of Neurology Southwestern Med School Univ of Texas Health Science Center at Dallas Dallas, TX 75235
1. Jones HM: Cranial pneumatocoele. Proc R Soc Med 63:257-262, 1970. 2. French LA, Chou SN: Osteomyelitis of the skull and epidural abscess, in Gurdjian ES (ed): Cranial and Intracranial Suppuration. Springfield, Ill, Charles C Thomas Publisher, 1969, pp 59-72. 3. Handel SF, Kelin WC, Kimy YW: Intracranial epidural abscess. Radiology 111:117-120, 1974. 4. Dorff GJ, Jackson LJ, Rytel MW: Infections with Eikenella corrodens: A newly recognized human pathogen. Ann Intern Med 80:305-309, 1974. 5. Marsden HB, Hyde WA: Isolation of Bacteroides corrodens from infections in children. J Clin Pathol 24:117-119, 1971.
Arachnoiditis From Intrathecally Given Corticosteroids in the Treatment of Multiple Sclerosis To the Editor.\p=m-\Ina previous report,1 arachnoiditis and sterile meningitis were listed as serious side effects from methylprednisolone acetate given intrathecally to patients with acute-phase multiple sclerosis. In addition to the four previously reported patients with arachnoiditis, we have seen three others, bringing the total reported cases to seven. The following report is
typical. Report of a Case.\p=m-\Beginning36 years ago, a 53-year-old man developed retrobulbar neuritis, spasticity of the legs, paresthesia of the hands, and papillitis of the optic disks in exacerbations and remissions. Elsewhere, he was given a series of 16 intrathecal injections of methylprednisolone acetate (40 to 80 mg each) over a seven-year period. The spinal fluid protein content gradually
racic areas. They thesia of the legs
complaint might be related to the well-known elevation of spinal fluid protein and cell content following injections. Some investigators have found the protein and cell content to be directly related to the dosage of corticosteroid given. Patients with arachnoiditis thus far reported have shown a progression upward of spinal fluid protein level and a steady downhill course in leg strength and bladder function. This combination of events may well be a sign of arachnoiditis, and the harbinger of a complete spinal fluid block. The dangers of adhesive arachnoiditis and the findings of insignificant rates of improvement in several studies indicate little rationale for this mode of therapy in patients with multiple sclero¬ sis. D. Nelson, MD Wilmington Med Center Wilmington, DE 19899 1. Nelson
DA, Vates TS Jr, Thomas RB Jr: Complications from intrathecal steroid therapy in patients with multiple sclerosis. Acta Neurol Scand 49:176-188, 1973.
Platelet Hyperaggregability in Young Patients With Stroke To theEditor.\p=m-\The
interesting article by Kalendovsky et al, on platelet hyperaggregability in young patients with stroke, in the January 1975 issue of the Archives (32:13,1975) prompts me to make this report (March 1975) of results obtained from a pilot study conducted on 15 patients with stroke (mean age, 63 years) vs 15 control patients of the same age, 15 young asymptomatic persons (mean age, 25 years) and 15 other patients given anticoagulant therapy with warfarin sodium (Coumadin) (mean prothrombin time, 20.6 sec-
onds).
corticosteroids continue to be administered to many patients for the treatment of arachnoiditis following surgery for disk disease, and for the treatment of multiple sclerosis. The lack of complications reported in patients treated for disk complica¬ tions may be due to the difficulty of evaluating possible "new" arachnoiditis added to chronic arachnoiditis. Also, there may be a difference in the pathophysiology of arachnoiditis in patients with disk disease as compared to those with multiple sclerosis. Patients who are given methylprednisolone
intrathecally
prone to develop arachnoiditis in the upper lumbar and midthoacetate
seem
Downloaded From: http://archneur.jamanetwork.com/ by a University of Manitoba User on 06/18/2015
One of the coagulation tests performed was designed here. It consisted of drawing 10 ml of fresh venous blood, placing 0.5 ml in each of ten funnel-shaped glass tubes, then leaving it to clot. Exactly 15 and 30 minutes after the blood had been drawn, each set of five clot-containing glass tubes was subjected to a continuously increasing pressure induced by pumped isotonic saline, until the clots gave away. All pressures recorded from each set were averaged (we termed this test "mechanical clot resistance"). The results from this test (Figure) showed that the 15 stroke patients had a significantly higher mean clot resistance as compared to both control groups (P .01). Two other strokes due to hyper¬ tensive hemorrhage, one embolie case secondary to auricular fibrillation, and one stroke with simultaneous disseminated intravascular coagu¬ lation all showed "normal" or low mean values. The young control group demonstrated practi¬ cally the same mean values as those of the similar-age control group. But two young women had high values equivalent to those of the stroke group. Both of them suffered chronic migraine headaches. Using the aggregometer in vitro, the hyperaggregability of platelets showed no significant statistical differences between the various groups (16%). Diabetes (37%) and hyperlipidemias (types II and IV, 42%) were also not significantly different. On the other hand, hyper¬ tension (42%) and electrocardiographic evidence of previous myocardial infarction (28%) were both significantly different factors (P .05 and =
=
=
.025, respectively).
It is of interest to note that independent studies of cerebrovascular disease, using differ¬ ent coagulation indexes, have shown seemingly consistent abnormal results.14 This information is offered only to add further
Time sequence of mechanical clot resistance. Values
given
are mean
of each group.
450
increased from 82 to 159 mg/100 ml. He had subjective spasticity of the legs during a five\x=req-\ year period that necessitated hospitalization in 1974. A myelogram revealed multiple adhesions in the subarachnoid space at T-1 through T-4 and T-12 through L-2. Loculated iophendylate (Pantopaque) was trapped in these areas and did not move although the patient was placed in the sitting position for several hours. Surgery was not recommended1 because of the multiple levels of the lesions.
Comment.—Intrathecally given
frequently complain of pares¬ following such injections. This
411
261
Hypercoagulable Stroke Group Controls of Similar Age Young Controls
208 76 Warfarin Sodium Patients
200
8
10
12
18
20
22
24
26
28
30
