Bahram Mokri's research while affiliated with Mayo Clinic - Rochester and other places

Publications (135)

Article
Full-text available
Background and objective Epidural blood patch (EBP) is a safe and effective treatment for spontaneous intracranial hypotension (SIH), but clinical and procedural variables that predict EBP efficacy remain nebulous. Methods This study is an institutional review board-approved retrospective case series with dichotomized EBP efficacy defined at 3 mon...
Article
Full-text available
Objective/background: We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass inde...
Article
Purpose: To re-evaluate the population-based incidence of idiopathic intracranial hypertension (IIH) and to determine if it mirrors the rise in obesity. Design: Retrospective, population-based cohort. Participants: All residents of Olmsted County, Minnesota, diagnosed with IIH between January 1, 1990, and December 31, 2014. Methods: All case...
Article
Full-text available
Injection of fibrin glue mixed with blood into the epidural space to reliably and effectively treat medically refractory orthostatic headache caused by spinal cerebrospinal fluid (CSF) leaks and subsequent intracranial hypotension has recently been described. The study described in this article utilizes an analogous technique to gauge the therapeut...
Article
A broadening of the clinical and imaging features of the spontaneous cerebrospinal fluid (CSF) leaks is now well recognized, far beyond what was thought only two decades ago. This has resulted in increasing number of patients with atypical and unusual features who, not unexpectedly, are directed to headache specialists and tertiary referral centers...
Article
Practically all cases of spontaneous intracranial hypotension results from spontaneous cerebral spinal fluid (CSF) leaks, often at the level of the spine and only rarely from the skull base. The triad of orthostatic headaches, diffuse pachymeningeal enhancement on head imaging and low CSF opening pressure is considered the hallmark of these leaks b...
Article
Headache is the most common symptom in spontaneous CSF leaks, frequently associated with additional manifestations. Herein, attention is drawn to movement disorder as a notable manifestation of spontaneous CSF leaks. Four women and one man (ages 51-78 years) with spontaneous CSF leaks and movement disorders were evaluated clinically and by pertinen...
Article
Objective: To highlight the occurrence of spontaneous cerebrospinal fluid (CSF) leak in the setting of Klippel–Trenaunay–Weber syndrome (KTWS). Background: KTWS is a congenital multicomponent disorder of angiogenesis plus limb asymmetry. The cause of spontaneous CSF leaks often remains unknown, but the notion of a pre-existing dural weakness rel...
Article
Spontaneous intracranial hypotension typically results from spontaneous cerebrospinal fluid (CSF) leak, often at spine level and only rarely from skull base. Once considered rare, it is now diagnosed far more commonly than before and is recognized as an important cause of headaches. CSF leak leads to loss of CSF volume. Considering that the skull i...
Article
Full-text available
Object: Patients with brachial plexus injury (BPI) present with a combination of motor weakness/paralysis, sensory deficits, and pain. Brachial plexus injury is generally not believed to be associated with headaches. However, CSF leaks may be associated with CSF volume-depletion (low-pressure) headaches and can occur in BPI secondary to nerve root...
Article
Ventral spinal epidural meningeal cysts are rare entities for which the pathogenesis is poorly understood. We present the clinical, radiographic, surgical, and pathologic findings of 4 patients with extensive ventral spinal epidural meningeal cysts and review the relevant literature. In addition, we discuss a suspected mechanism for pathogenesis. F...
Article
Orthostatic headache related to spontaneous cerebrospinal fluid leak (CSF) appears within 2 h of sitting or standing in most patients. However, longer delays to headache onset have been observed, including some patients who have headaches only in the afternoon. The objective of this study is to describe second-half-of-the-day headache as a manifest...
Article
To report the clinical phenotype and outcome of isolated paraneoplastic myelopathy. We systematically reviewed clinical, serologic, and MRI data for 31 patients (20 female) who presented with an isolated myelopathy and coexisting cancer: carcinoma (lung, 9; breast, 7; kidney, 2; thyroid, 2; ovary/endometrium, 2), melanoma (2), or other cancer (3),...
Article
The clinical and radiographic manifestations of spontaneous intracranial hypotension are highly variable and many patients do not satisfy the 2004 International Classification of Headache Disorders criteria. We developed new diagnostic criteria for spontaneous intracranial hypotension based on cases we have seen reflecting the variable manifestatio...
Article
Behavioral variant frontotemporal dementia (bvFTD) is a relatively well-defined clinical syndrome. It is associated with frontal and temporal lobe structural/metabolic changes and pathologic findings of a neurodegenerative disease. We have been evaluating patients with clinical and imaging features partially consistent with bvFTD but with evidence...
Conference Paper
Introduction Brachial plexus injury presents with a combination of motor weakness/paralysis, sensory deficits, and pain. Headaches are generally not thought to be associated with brachial plexus injury. However, it is well known that CSF leaks, either spontaneous or not, may be associated with low-pressure headaches and CSF leaks can occur in bra...
Article
Intracranial dissections have been associated with baroreceptor reflex failure. When this occurs labile hypertension may be observed with its own complications, including but not limited to the clinico-radiographic entity, posterior reversible encephalopathy syndrome (PRES). Case report and literature review. We describe a case of carotid dissectio...
Article
To draw attention to the syndrome of the trephined as a potential cause for orthostatic headaches without cerebrospinal fluid (CSF) leak. Orthostatic headaches typically result from CSF leaks but sometimes may occur in conditions without any evidence of CSF leakage. A 37-year-old right-handed woman became comatose after a motor vehicle accident wit...
Article
Objective: To evaluate the cancer detection rate of whole-body positron emission tomography-computed tomography (PET-CT) in a paraneoplastic neurologic context. Design: Retrospective medical record review. Setting: Mayo Clinic, Rochester, Minnesota. Patients: Fifty-six consecutive patients with clinically suspected paraneoplastic neurologic disorde...
Article
To evaluate the cancer detection rate of whole-body positron emission tomography-computed tomography (PET-CT) in a paraneoplastic neurologic context. Retrospective medical record review. Mayo Clinic, Rochester, Minnesota. Fifty-six consecutive patients with clinically suspected paraneoplastic neurologic disorders who underwent PET-CT after negative...
Article
A source of bleeding is often not evident during the evaluation of patients with superficial siderosis of the CNS despite extensive imaging. An intraspinal fluid-filled collection of variable dimensions is frequently observed on spine MR imaging in patients with idiopathic superficial siderosis. A similar finding has also been reported in patients...
Article
To describe the syndrome of orthostatic headache without CSF leak and propose potential mechanisms. From among 125 patients referred to one of us (B.M.) over a 5-year period for evaluation of orthostatic headache and suspected CSF leak, those patients with negative head and spine MRI, normal radioisotope cisternography and CT myelography, and norma...
Article
Spontaneous intracranial hypotension (SIH) was described nearly 70 years ago, and for years it was essentially equated with post dural puncture headaches (PDPH) (1). The interest in this entity substantially increased after the magnetic resonance imaging (MRI) abnormalities of this disorder were recognized in the early 1990s (2-6), and consequently...
Article
Two sisters developed spontaneous cerebrospinal fluid (CSF) leaks from meningeal diverticula. Both had recurrences from non diverticular sites. Both patients, a sister, and their mother had joint hypermobility and there was a strong family history of thoracic and abdominal aorta aneurysms. To my knowledge, this is the first report of familial occur...
Article
Incidence rates for internal carotid artery dissection (ICAD) have been reported to be 2.6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery dissection (VAD) are not available. To determine the incidence rate of cervical artery dissection (CAD) in a defined population. With IRB approval, we used the medical record linkage sys...
Article
A 59-year-old man presented with orthostatic headaches, memory complaints, pronounced choreiform movements, and related hyperkinetic dysarthria and titubations. Head MRI findings were suggestive of CSF leak. CSF pressure was low. CT myelography documented CSF leak at the cervicothoracic junction. Targeted epidural blood patch led to resolution of s...
Article
Spontaneous intracranial hypotension is typically caused by a spontaneous spinal cerebrospinal fluid (CSF) leak. The configuration of the related dural defects can be complex. We describe our experience with the surgical anatomy of these defects. Thirteen consecutive patients with spontaneous spinal CSF leaks who underwent surgical exploration at M...
Article
Full-text available
Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), often termed Hashimoto encephalopathy, is a poorly understood and often misdiagnosed entity. To characterize the clinical, laboratory, and radiologic findings in patients with SREAT to potentially improve recognition of this treatable entity. Retrospective analysis of...
Article
Amphiphysin-IgG was identified in 71 patients among 120,000 evaluated serologically for paraneoplastic autoantibodies. Clinical information was available for 63 patients. Cancer was detected in 50 (mostly limited), proven histologically in 46, and was imaged intrathoracically in 4 patients (lung, small-cell [27] and non-small cell [1]), breast [16]...
Article
MR imaging has truly revolutionized the diagnosis of spontaneous intracranial hypotension (SIH). A substantially larger number of patients are now diagnosed and a broader clinical and imaging spectrum of the disorder is recognized. It is now realized that SIH nearly always results from spontaneous CSF leaks. The majority of these leaks occur at the...
Article
Two patients with cerebrospinal fluid (CSF) leak, one at the level of fourth thoracic spine and another with undetermined level of leak, presented with paradoxical postural headaches in that the headaches were present when in a horizontal position and resolved if the patients were upright. One patient improved spontaneously and the other responded...
Article
The majority, if not all, of the cases of spontaneous intracranial hypotension result from spontaneous cerebrospinal fluid (CSF) leaks. The disorder has a broad clinical and imaging spectrum with substantial variability in clinical and imaging features, in CSF findings, and in response to treatment. Headache is the most common symptom and is typica...
Article
Seven patients, after seemingly uncomplicated surgery for ascending aorta aneurysm or dissection, with or without aortic valve replacement, developed an unusual and fairly stereotyped biphasic neurologic disorder without imaging evidence of related cerebral ischemia or infarct. The initial phase was mild, nonprogressive, or receding. The latent and...
Article
Only 12 years ago the first report on pachymeningeal gadolinium enhancement in low-pressure headaches appeared in the literature. In this short interval the enormous impact of MRI on so-called "spontaneous intracranial hypotension" and "low-pressure head-aches" has become obvious. A much broader clinical and imaging spectrum of the disease is now r...
Article
Four women age 17 to 28 years presented with orthostatic headaches as the most prominent feature of their symptom complex. None had CSF leak or intracranial hypotension. Autonomic studies showed evidence of orthostatic intolerance with tachycardia in all cases. Treatment of orthostatic intolerance, mainly with volume expansion, was only partially e...
Article
In some patients with spontaneous spinal CSF leaks, leaks are numerous or tears are so large that extrathecal myelographic contrast material is seen at multiple levels during CT, making identification of their source impossible. This study introduces a dynamic CT myelographic technique that provides high temporal and spatial resolution. In this tec...
Article
More patients with spontaneous intracranial hypotension are now being diagnosed, and it is realized that most cases result from spontaneous cerebrospinal fluid leaks. A broader clinical and imaging spectrum of the disorder is recognized. This paper reviews new insights into the variability of clinical manifestations, imaging features, etiological f...
Article
Spontaneous CSF leaks are increasingly recognized, and a broader clinical and imaging spectrum of the disorder is emerging. The headaches of CSF leaks are typically orthostatic, but sometimes especially with chronicity the orthostatic features are blurred into lingering chronic daily headaches. Additional types of headache are also increasingly rec...
Article
Four patients, aged 10 to 44 years, with spontaneous cerebrospinal fluid (CSF) leaks and intracranial hypotension developed intracranial hypertension after treatment of their CSF leaks. The leak was at the spinal level in all patients (thoracic level, 2; lumbar level, 1; and undetermined, 1). One patient responded to an epidural blood patch. Three...
Article
Internal carotid artery (ICA) and vertebral artery (VA) dissections are among the common causes of stroke in middle-aged and young adults. The spectrum of clinical presentations of these dissections is broad. Many patients, especially those with ICA dissections, may never develop a stroke.
Article
Among patients with spontaneous internal carotid artery (ICA) or vertebral artery dissections, there is a small but significant risk of development of dissection in an uninvolved ICA or vertebral artery at some time in the future. Recurrence of dissection in a previously dissected and healed ICA or vertebral artery is very rare. We retrospectively...
Article
OBJECTIVE AND IMPORTANCE : Among patients with spontaneous internal carotid artery (ICA) or vertebral artery dissections, there is a small but significant risk of development of dissection in an uninvolved ICA or vertebral artery at some time in the future. Recurrence of dissection in a previously dissected and healed ICA or vertebral artery is ver...
Article
Internal carotid artery (ICA) and vertebral artery (VA) dissections are among the common causes of stroke in middle-aged and young adults. The spectrum of clinical presentations of these dissections is broad. Many patients, especially those with ICA dissections, may never develop a stroke.
Article
Corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (also called Hashimoto's encephalopathy) is a rare, life-threatening, treatable, and possibly autoimmune condition. We identified nine patients (with the diagnosis made after 1979) who had relapsing encephalopathy compatible with previous reports of Hashimoto's encephal...
Article
Of 58 consecutive patients with spontaneous CSF leaks, nine exhibited features of connective tissue disorder. One had Marfan's syndrome. Five additional patients had hyperflexible joints, of whom four had arachnodactyly, four were tall and slender, two had hyperextensible skin, and one had a strong family history of abdominal aorta aneurysms. Retin...
Article
Cerebrospinal fluid (CSF) leak is recognized to cause headaches that typically but not invariably have orthostatic features (present in upright posture, relieved by recumbency). Head magnetic resonance imaging (MRI) typically shows diffuse pachymeningeal enhancement. A 24-year-old woman, after resection of a right temporoparietal glioma, developed...
Article
Of 25 consecutive patients with spontaneous CSF leaks treated with epidural blood patch (EBP), nine patients (36%) responded well to the first EBP. Of 15 patients who received a second EBP, five became asymptomatic (33%). Of eight patients who received three or more EBP (mean 4), four patients (50%) responded well.
Article
More than two centuries ago, Alexander Monro applied some of the principles of physics to the intracranial contents and for the first time hypothesized that the blood circulating in the cranium was of constant volume at all times. This hypothesis was supported by experiments by Kellie. In its original form, the hypothesis had shortcomings that prom...
Article
Spontaneous intracranial hypotension (SIH) is typically manifested by orthostatic headaches that may be associated with one or more of several other symptoms, including pain or stiffness of the neck, nausea, emesis, horizontal diplopia, dizziness, change in hearing, visual blurring or visual field cuts, photophobia, interscapular pain, and occasion...
Article
CSF volume depletions, whether from leak or shunt overdrainage, typically cause low CSF opening pressures, orthostatic headaches, and diffuse pachymeningeal gadolinium enhancement on MRI. The authors report three patients-two with overdraining CSF shunts and one with proven CSF leak-with the typical pachymeningeal enhancement but without headaches....
Article
The authors describe five patients with typical clinical and MRI features of CSF leak and large enhancing pituitaries. The source of CSF leak was identified and surgically repaired in three patients. This was followed by disappearance of clinical symptoms and resolution of MRI abnormalities, including the pituitary enlargement. Enhancing enlargemen...
Article
Among 111 patients with vertebral artery dissection (VAD), two presented with spinal manifestations: one with a C5-C6 radiculopathy and the other with a cervical myelopathy. Of 13 previously reported cases of spinal manifestations of VAD (mean age 37 years), ischemic cervical myelopathy was noted in seven; cervical radiculopathy, often at C5-C6 and...
Article
Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension. In this report the authors review the indications for surgery, surgical techniques, and surgery-related outcomes for these lesions. The major presenting symptoms include postural headaches, nausea, vomiting, and diplopia. Often, ther...
Article
Cerebrospinal fluid (CSF) volume depletion, due to CSF leakage or CSF shunt overdrainage, is typically indicated when patients present with orthostatic headaches, with or without several other symptoms: neck or interscapular pain, nausea, emesis, diplopia, changes in hearing, visual blurring, facial numbness or weakness, and radicular upper-limb sy...
Article
Intracranial hypotension causes orthostatic headaches and diffuse pachymeningeal gadolinium enhancement on magnetic resonance imaging with or without subdural fluid collections or imaging evidence of descent of the brain. A review of the literature and my experience and investigations in the past decade reveal a broadening clinical and imaging spec...
Article
CSF leak is recognized to cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPMGE) on MRI. We report six patients with typical symptoms and documented CSF leaks without DPMGE. Two had normal meninges from the onset; one initially had normal meninges, but subsequently DPMGE developed. In three, the initially noted DPMGE...
Article
L-asparaginase (L-asp) has become an important component of combination chemotherapy for acute lymphoblastic leukemia (ALL). However, L-asp can produce depletions in many of the clotting factors with an associated risk for thrombosis and hemorrhage. Three consecutive patients seen at the Mayo Clinic with L-asp related thrombosis are described and a...
Article
To report that the syndrome of orthostatic headaches caused by CSF leak can be seen with persistently normal CSF pressures. CSF leak or shunt overdrainage is known to cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPGE), typically associated with unmeasurable or very low CSF pressures. Of 40 consecutive patients with...
Article
Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in se...
Article
This chapter describes spontaneous dissections of cervicocephalic arteries. Of the cervicocephalic arteries, the artery that is most commonly involved by dissection is the extracranial segment of the internal carotid artery (ICA). The vertebral artery (VA) is the second most commonly involved vessel. Extracranial VA dissections may extend intracran...
Article
Recurrent dissections involving carotid, vertebral, or renal arteries have been described in patients with spontaneous cervical artery dissections, with a maximal interval between dissections of fourteen years. The authors describe 2 patients in whom aortic dissections developed twenty-five and forty years, respectively, following carotid artery di...
Article
To characterize clinical and imaging features, biopsy findings, etiologic factors, and outcome in the syndrome of intracranial hypotension, headaches, and diffuse pachymeningeal gadolinium enhancement on magnetic resonance imaging (MRI). We describe our experience with 26 consecutive patients with orthostatic headaches and diffuse pachymeningeal ga...
Article
BACKGROUND- Internal carotid artery (ICA) dissections are among the common causes of ischemic strokes in young and middle-aged adults. Most patients with ICA dissections, however, present with a variety of other manifestations and never develop strokes. The disease is much more common than was initially thought. REVIEW SUMMARY- In this article, the...
Article
The number of patients with congenital heart disease who survive to adolescence and adulthood continues to increase. We review our experience with noninfectious intracranial aneurysms and cervicocephalic arterial dissections in patients with congenital heart disease, expanding the clinical spectrum of the cerebrovascular abnormalities that may be e...
Article
Full-text available
Spinal cerebrospinal fluid (CSF) leaks are often implicated as the cause of the syndrome of spontaneous intracranial hypotension, but they have rarely been demonstrated radiographically or surgically. The authors reviewed their experience with documented cases of spinal CSF leaks of spontaneous onset in 11 patients including their surgical observat...
Article
Among patients with spontaneous cervical artery dissections, the risk of recurrent arterial dissection is relatively low at 1% per year, but this risk may be higher for patients with a family history of arterial dissections. We compared the risk of a recurrent arterial dissection in patients with familial versus non familial disease. Long-term foll...
Article
Cranial nerve palsy was present in 23 of 190 consecutive adult patients (12%) with spontaneous dissection of the extracranial internal carotid artery. Ten patients (5.2%) had a syndrome of lower cranial nerve palsies (with invariable involvement of cranial nerve XII with or without additional involvement of cranial nerves XI, X, and IX), seven (3.7...
Article
A 41-year-old man with low back pain and lumbar disc disease was found to have L-3 butterfly vertebra on imaging studies as an incidental finding. This uncommon congenital anomaly of the vertebral column is usually asymptomatic and of no clinical significance. Awareness of this deformity and its imaging features is important diagnostically.
Article
A primary arteriopathy is often implicated in the etiology of spontaneous cervicocephalic arterial dissections, but its exact nature usually remains unknown. We describe the familial occurrence of spontaneous arterial dissections and congenitally bicuspid aortic valve (BAV) and propose a common developmental defect in these families. In the first f...
Article
Intracranial hypotension is a cause of diffuse enhancement of the pachymeninx with gadolinium, which often is associated with subdural fluid collections. We reviewed the results of meningeal biopsy in six patients with intracranial hypotension and diffuse pachymeningeal enhancement to correlate the MRI findings with histopathologic observations and...
Article
We studied the characteristics of headaches in 161 consecutive symptomatic patients with spontaneous dissections of the internal carotid artery (n = 135) or the vertebral artery (n = 26). For patients with internal carotid artery dissection (ICAD), the mean age was 47 years and for those with vertebral artery dissection (VAD), 40.7 years. A history...
Article
Arterial dissection occurs when blood enters a vessel wall through an intimal tear and a false lumen of blood is formed within the media.1,2 The artery most commonly affected by dissection is the aorta,1 followed by the renal3,4 and extracranial internal carotid2,5 arteries. The pathogenesis of arterial dissection is incompletely understood, but a...
Article
A number of reports have suggested an increasing incidence of primary brain tumors, especially malignant astrocytomas, in the elderly population. To investigate this issue, we analyzed the incidence and temporal trends of primary intracranial neoplasms diagnosed in the population of Rochester, Minnesota, over the 40 years between 1950 and 1990. The...
Article
Aneurysms of the extracranial internal carotid artery (ICA) are uncommon. A significant proportion of such aneurysms are now recognized to be caused by arterial dissection. In some patients, surgical treatment may become necessary. The surgical treatment of 22 patients with spontaneous or traumatic dissecting aneurysms arising from the extracranial...
Article
To determine the ophthalmic manifestations of vertebral artery dissections. Fifty-one separate episodes of vertebral artery dissections evaluated at the Mayo Clinic from 1976 through 1992 were studied. In all cases, the diagnosis had been documented with angiography. There were 28 men and 19 women (mean and median age, 39 and 40 years, respectively...
Article
Among 263 consecutive patients with spontaneous cervicocephalic arterial dissections evaluated at the Mayo Clinic, 18 (6.8%) were 18 years of age or younger (mean age, 12 years). The dissection involved the cervical arteries in 11 patients and the intracranial arteries in seven. Extracranially, the internal carotid artery was involved in eight pati...
Article
The natural history of arachnoid cysts is not uniform; some cysts enlarge and some remain unchanged. A less recognized course is spontaneous resolution. A patient with an arachnoid cyst that resolved spontaneously is described, previously reported cases of 6 patients are reviewed, and possible mechanisms for resolution of the cysts are discussed.

Citations

... Prior studies show widely varying results from a single empiric lumbar EBP [54] [55], with symptom relief ranging from 13 to 75% of patients and suggestion of some additional benefit from a second empiric lumbar EBP in initial non-responders. One study showed that a bilevel EBP performed in the lower thoracic and lumbar regions is more likely than a single-level lumbar patch to provide symptom relief and showed that a higher volume of injected blood is beneficial [56]. If a patient does not improve with nontargeted lumbar EBP, typically advanced myelographic techniques are used to attempt to identify the site of leak. ...
... Accurate localization of fast CSF leaks requires imaging modalities with sufficient temporal resolution to visualize the initial site of contrast extravasation into the epidural space. The two most commonly used modalities for fast leak localization are digital subtraction myelography (DSM) and dynamic CTM [2][3][4]. Dynamic imaging is crucial, because the precise leak site may not be identifiable if imaging occurs after contrast has leaked from the thecal sac and has had time to spread throughout the epidural space [4]. Treatment of fast CSF leaks with epidural blood patch, fibrin glue, or surgery is more effective if the exact leak is localized [5]. ...
... However, there is a maximum safe CSF pressure for each age group, even though CSF pressure fluctuates with age. A rise in intracranial pressure (ICP) is indicated when cerebrospinal fluid (CSF) pressure is above 200 mm H2O in children or 25 mm H2O in adults (1). ...
... There is a paucity of high-quality studies in the current literature on percutaneous fibrin sealant patching for IH. A comprehensive review of the literature revealed a total of 2 prospective case series, 4 retrospective case series with one in abstract format, and 11 case reports, as shown in Table 2 (7,13,16,18,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). There were no randomized controlled trials, only lower-quality studies including case reports and case series. ...
... The 15 epidural blood patches we attempted were as follows: the 1st epidural blood patch was a C6-7, interlaminar approach, 20.0 ml; 2nd was a C6-7, interlaminar approach, 12.0 ml and T1-2, interlaminar approach, 12.0 ml; 3rd was a C7-T1, interlaminar approach, 15 ml and T5-6, interlaminar approach, 10.0 ml; 4th was a C6-7, interlaminar approach, 15.0 ml and T4-5, interlaminar approach, 10.0 ml; 5th was a bilateral T2 transforaminal approach, 12.5 ml each; 6th was a T5-6, interlaminar approach, 20.0 ml; 7th was a T1-2, interlaminar approach, 20.0 ml; 8th was a C6-7, interlaminar approach, 10 Fig. 3. An interlaminar approach was used between C7 and T1, and a transforaminal approach was used between T1 and T2, and T2 and T3; the location was confirmed by injection of a contrast medium. ...
... Additionally, Mr. X had undergone Nerve Conduction study and the findings indicated "Mild Bilateral common peroneal nerve Axonal Neuropathy". In his medical report whole body the cases when other imaging modalities fail to diagnose PNS [8]. Further, through non-contrast MRI whole spine screening, a mild diffuse disc bulge at C5-6, L2-3 and L5-S1 levels with mild marginal osteophytes at lumbar level were identified. ...
... Two of them had epidural blood patches, one experienced prompt sustained symptomatic relief from a lumbar epidural blood patch, and the other required a second epidural blood patch, which was placed at a higher level, in the thoracic spine, after failure of the initial lumbar patch. Alternatively, epidural blood patches can be performed on an inclined table from a lumbar approach with Trendelenburg positioning, which allows the blood to be directed to the thoracic or cervical levels (13). Identifying the location of the spinal fluid collection might help direct the placement of a therapeutic epidural blood patch in patients who do not respond to conservative therapy (14). ...
... These differ from the International Classification of Headache Disorders, second edition (ICHD-2) criteria 4 by not specifying the time course of the headache and by not presuming that epidural blood patch (EBP) is uniformly effective, which it frequently is not. 24 ...
... Alguns investigadores procuram mostrar que a angio-RM de carótida é suficiente para detectar estenose de carótida. Masaryk A angio-RM tem sido muito útil também no diagnóstico de dissecções carotídeas, que aparecem como estenoses, irregulares, e principalmente nos cortes axiais ao nível da dissecção, mostrando pequenos círculos escuros, menores que a luz do vaso, com padrão de fluxo e com área circunjacente excêntrica hiperintensa, mais clara, representando o trombo intramural 18 . ...
... 36 However, generalized connectivetissue disorders have been identified in one fourth of patients with such dissections, and the initial symptoms of vertebral-artery dissection commonly mimic the musculoskeletal neck pain for which people go to chiropractors. 37 A recent history of a respiratory tract infection is a risk factor for spontaneous dissections of the carotid or vertebral artery 38 ; however, an infection with Chlamydia pneumoniae or mechanical factors such as coughing or vomiting do not appear to be the cause. 38 The possibility of an infectious trigger is supported by the finding of a seasonal variation in the incidence of spontaneous dissections of the carotid and vertebral arteries, with a peak incidence in the fall. ...