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Chronic myelopathy due to a giant spinal arachnoid cyst: a complication of the intrathecal injection of phenol

Case report

Fred Rincon, J. Mocco, Ricardo J. Komotar, Alexander G. Khandji, Paul C. McCormick, and Marcelo Olarte

T he intrathecal injection of alcohol or phenol for spinal neurolysis has been an effective but invasive alternative to treat chronic pain syndromes. It was first introduced in 1931 by Dogliotti for the treatment of sciatic pain and has gained popularity among anesthesiologists and pain management specialists as a useful technique to treat recalcitrant chronic pain states in patients with cancer 11 and acquired spasticity. 3 , 9 The procedure is designed to irreversibly ablate sensory axons of posterior roots, thereby damaging the afferent pain pathways

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Complication Following Intrathecal Injection of Fluorescein

Case Report

M. S. Mahaley Jr. and G. L. Odom

generalized central nervous system irritation. It seems possible that the meningeal inflammation associated with this reaction sealed the site of cerebrospinal fluid leak, which had prompted the study. However, the rather alarming circumstances associated with this study serve to emphasize the warning stated by Fox in 1933 relative to indigo carmine: “The danger of stirring up a meningitis should also be kept in mind.” 2 Summary We have reported a case in which severe neurological complications arose following the intrathecal injection of fluorescein in a search for

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Inadvertent intrathecal vincristine administration: a neurosurgical emergency

Case report

Maher Qweider, Joachim M. Gilsbach, and Veit Rohde

, Wheeler HR , Shenfield GM : Glutamate ameliorates experimental vincristine neuropathy . J Pharmacol Exp Ther 279 : 410 – 415 , 1996 8 Dettmeyer R , Driever F , Becker A , Wiestler OD , Madea B : Fatal myeloencephalopathy due to accidental intrathecal vincristine administration: a report of two cases . Forensic Sci Int 122 : 60 – 64 , 2001 9 Dyke WR : Treatment of inadvertent intrathecal injection of vincristine . New Engl J Med 321 : 1270 – 1271 , 1989 10 Fernandez CV , Esau R , Hamilton D , Fitzsimmons B , Pritchard

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Direct administration of methotrexate into the central nervous system of primates

Part 1: Distribution and degradation of methotrexate in nervous and systemic tissue after intraventricular injection

Harold K. Kimelberg, David Kung, Robert E. Watson, Frederick L. Reiss, Sandra M. Biddlecome, and Robert S. Bourke

described in the following paper 30 and as reported by others, 16, 24 does achieve higher levels in brain than intrathecal lumbar puncture, and much higher levels than found after intravenous infusion 14, 24 when predominantly 3 HMTX metabolites appear to enter the CNS in Cynomolgus monkeys. 14 Thus, the effective use of MTX for treatment of CNS-associated tumors would seem to require detailed knowledge both of its distribution patterns and levels after intraventricular or intrathecal injection as partly described in this and the accompanying paper, 30 and its

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Direct administration of methotrexate into the central nervous system of primates

Part 2: Distribution of 3H methotrexate after intrathecal lumbar injection

John Yen, Frederick L. Reiss, Harold K. Kimelberg, and Robert S. Bourke

✓ The kinetics of distribution of 3H methotrexate (3HMTX) in the central nervous system, plasma, and urine after intraventricular, lumbar percutaneous puncture, and spinal catheter injections were compared. Levels of 3HMTX in whole brain after lumbar percutaneous injection were 40 times less than after intraventricular injection. Injection of 3HMTX via a spinal catheter increased the level of 3HMTX in whole brain but this was still tenfold less than after direct intraventricular instillation. Also, it was found that a disproportionately high amount of 3HMTX was in the brain-stem-cerebellum region which would further reduce the concentration of methotrexate in the cerebral hemispheres. Both intraventricular and lumbar spinal catheter administration of 3HMTX produced 3HMTX levels greater than 10−6M (moles/kg wet weight) in spinal cord tissue as measured by 3H specific activity between 2 to 8 hours after injection. Administration by lumbar percutaneous puncture, however, rarely resulted in this suggested therapeutic level of 10−6M. Initial 3HMTX levels in plasma after lumbar percutaneous instillation was 24 times greater than after intraventricular or lumbar spinal catheter injections. This indicated significant and unavoidable extradural leakage after lumbar percutaneous puncture, which may account for the substantially lower levels of 3HMTX in the brain and spinal cord tissue. It is concluded that intraventricular instillation of methotrexate is the best route of administering the drug to achieve therapeutic levels of methotrexate in both whole brain and throughout the spinal cord.

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Status epilepticus as a complication of intrathecal fluorescein

Case report

Jan D. Wallace, Michael I. Weintraub, Richard H. Mattson, and Robert Rosnagle

identification and localization of cerebrospinal fluid, rhinorrhea and otorrhea. Laryngoscope 70 : 921 – 931 , 1960 Kirchner FR, Proud GO: Method for the identification and localization of cerebrospinal fluid, rhinorrhea and otorrhea. Laryngoscope 70: 921–931, 1960 8. Mahaley MS Jr , Odom GL : Complication following intrathecal injection of fluorescein: case report. J Neurosurg 25 : 298 – 299 , 1968 Mahaley MS Jr, Odom GL: Complication following intrathecal injection of fluorescein: case report. J Neurosurg 25

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Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator

Kazuo Mizoi, Takashi Yoshimoto, Akira Takahashi, Satoru Fujiwara, Keiji Koshu, and Takayuki Sugawara

. Patient selection for intrathecal injection therapy of tissue-type plasminogen activator (tPA) was made according to the computerized tomography (CT) findings of a subarachnoid hemorrhage. Underlined numerals indicate the Hounsfield units of the hematoma in each region of interest. Left: Representative CT scans in the tPA group. Right: Representative CT scans in the control group. TABLE 1 Characteristics of patients in both treatment groups * Variable tPA Group Control Group Significance (p Value) sex (F:M) 14

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Intrathecal phenol and glycerin in metrizamide for treatment of intractable spasms in paraplegia

Case report

LCDR Brett A. Scott, Zelig Weinstein, Robert Chiteman, and CDR Morris W. Pulliam

S pasticity resulting from corticospinal tract lesions in brain and spinal cord is seen in many neurological conditions. Infrequently, spontaneous spasms and contractures associated with upper motor neuron disease are incapacitating and add to the patient's handicap. Various treatments, including surgical rhizotomy 1, 10, 15 and radiofrequency percutaneous rhizotomy, 4, 5 percutaneous embolization of the artery of Adamkiewicz to produce spinal cord infarction, 14 continuous percutaneous epidural neurostimulation, 11–13 and intrathecal injection of

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Uptake of tritiated methotrexate by mouse brain tumors after intravenous or intrathecal administration

Yukitaka Ushio, Toru Hayakawa, and Heitaro Mogami

administration respectively. Comparison of the drug concentrations in tumor and brain tissue, and of the tumor/brain concentration ratios for the different types of tumor and the different administration routes of the drug yielded the data in Table 2 . TABLE 2 Distribution of radioactivity 24 hours after intravenous or intrathecal injection of methotrexate- 3 H Type of Tumor Route * No. of Mice MTX- 3 H Concentration (×10 4 dpm/gm Wet Tissue) † Tumor/Brain Concent. Ratio ‡ Tumor Brain malignant glioma i.v. 4 9

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Two types of curves for transfer of RIHSA from cerebrospinal fluid to plasma in patients with normal pressure hydrocephalus

Simon Behrman, Ian Cast, and P. O'Gorman

defined groups ( Fig. 1 ). Group A is characterized by a rapid rise of activity with the appearance of a high plateau after 6 to 12 hrs. Group B shows a slow progressive rise with no tendency to form a plateau. There is some overlap of the curves up to 9 hrs, but thereafter the divergence becomes pronounced. The counts for each case after 12 and 24 hrs are shown in Table 1 , and the histogram of the counts after 12 hrs are shown in Fig. 2 . Fig. 1. Graph showing upper and lower limits of blood radioactivity after intrathecal injection of RIHSA in Group A