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Berlin, Springer-Verlag, 1957, pp 1600 1672 HEAD H, RIDDOCH G: The automatic bladder: Excessive sweating and some other re ex conditions in gross injuries of the spinal cord Brain 40:188, 1917 HEISS JD, PATRONAS N, DEVROOM HL, et al: Elucidating the pathophysiology of syringomyelia J Neurosurg 91:553, 1999 HERRICK M, MILLS PE JR: Infarction of spinal cord Arch Neurol 24:228, 1971 HIRAYAMA K, TOKUMARU Y: Cervical dural sac and spinal cord in juvenile muscular atrophy of distal upper extremity Neurology 54:1922, 2000 HOLMES G: On the spinal injuries of warfare: Goulstonian lectures BMJ 2:769, 1915 HOWELL DA, LEES AJ, TOGHILL PJ: Spinal internuncial neurones in progressive encephalomyelitis with rigidity J Neurol Neurosurg Psychiatry 42:773, 1979 HUGHES JT: Pathology of the Spinal Cord, 2nd ed Philadelphia, Saunders, 1978 HUGON J, LUDOLPH A, ROY DN, et al: Studies on the etiology and pathogenesis of motor neuron diseases: II.

and the infusion of 1000 to 2000 mL of 5% glucose are usually recommended but are of uncertain bene t The most dependable treatment is a blood patch (spinal epidural injection of a few milliliters of the patient s own blood) At least 75 percent of patients are thus relieved of the headache, according to Safa-Tisseront and colleagues; they report that after a second injection, improvement is effected in 97 percent Many patients have transient back or radicular pain (sciatica) following the blood patch Curiously, the headache is often relieved almost immediately even if the blood is injected at some distance from the original puncture (although the procedure is usually done at the same level as the previous spinal tap) Moreover, the volume of blood injected, usually about 20 mL, is not related to the chances of success.

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Clinical and electrophysiologic features of pyramidal dysfunction in macaques fed Lathyrus sativus and IDPN Neurology 38:435, 1988 HURLBERT RJ: Methylprednisolone for acute spinal cord injury: An inappropriate standard of care J Neurosurg 93:1, 2000 HURST RW, GROSSMAN RI Peripheral spinal cord hypointensity on T2weighted MR images: A reliable imaging sign of venous hypertensive myelopathy Am J Neuroradiol 21:781, 2000 INAMASU J, HORI S, OHSUGA F, et al: Selective paralysis of the upper extremities after odontoid fracture: Acute central cord syndrome or cruciate paralysis Clin Neurol Neurosurg 103:238, 2001..

The mechanism of this rapid improvement may not simply be the plugging of a dural leak A number of patients fail to bene t or have only transient effects; it is then unclear whether repeating the procedure is helpful The administration of caffeine-ergotamine preparations or intravenous caffeine may also have a salutary though temporary effect on the headache The addition of analgesic medication is required if the patient must get up to care for himself or to travel In protracted cases, patience is called for, since most headaches will resolve in 2 weeks or less As to mechanism, Panullo and colleagues have shown that there is a downward displacement of the upper brainstem and posterior fossa contents when the patient assumes the upright position; but, as pointed out in Chap 17, only rarely are there associated signs of brain herniation, the exceptions being some of the unusual cases discussed below.

ease tend, after a time, to become suspicious, uncooperative, and hostile toward their physicians or anyone who might question the authenticity of their illness. One notes in them a tendency to describe their pain vaguely and a preference to discuss the degree of their disability and their mistreatment at the hands of the medical profession. The description of the pain may vary considerably from one examination to another. Often also, the region(s) in which pain is experienced and its radiation are nonphysiologic, and the condition fails to respond to rest and inactivity. These features and a negative examination of the back should lead one to suspect a psychologic factor. A few patients, usually frank malingerers, adopt the most bizarre gaits and attitudes, such as walking with the trunk exed at almost a right angle (camptocormia), and are unable to straighten up. Or the patient may be unable to bend forward even a few degrees, despite the absence of muscle spasm, and may wince at the slightest pressure, even over the sacrum, which is seldom a site of tenderness unless there is pelvic disease. The depressed and anxious patient with back pain represents a troublesome problem. A common error is to minimize the importance of anxiety and depression or to ascribe them to worry over the illness and its social effects. In these circumstances, common and minor back ailments e.g., those due to osteoarthritis and postural ache are enhanced and rendered intolerable. Such patients are still subjected to unnecessary surgical procedures. The disability seems excessive for the degree of spinal malfunction; misery, irritability, and despair are the prevailing features of the syndrome. One of the most reliable diagnostic features is the response to drugs or other measures that alleviate the depression (see Chap. 57).

Now we ll step back into the 7.0 WAD to demonstrate the migration process. Before we start, we need to look and make sure we don t see the 3.x WAD template in the list of the 7.0 WAD templates. The following illustrations show the process of logging onto the 7.0 WAD and then doing a search for the 3.x version template within the 7.0 environment.

Miyazawa and colleagues have forwarded the interesting ndings that hypovolemia of the CSF, rather than lowered pressure, is the cause of downward displacement of the.

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