Title A Handbook of Statistical Analyses Using R (2nd Edition)Author Brian S. Everitt and Torsten HothornMaintainer Torsten Hothorn <[email protected]>Description Functions, data sets, analyses and examples from the second edition of the book`A Handbook of Statistical Analyses Using R' (Brian S. Everitt and TorstenHothorn, Chapman & Hall/CRC, 2008). The first chapterof th
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Microsoft word - lumbar thoracicmyelogram.rtfHampton Roads Radiology Associates
Lumbar and Thoracic Myelogram
Your referring physician has requested that you have a lumbar (or thoracic) myelogram. The following is a description of the procedure and adescription of the potential complications, so that you can give informedconsent to have the procedure.
A myelogram is an invasive procedure with some uncommon risks, so you will need to give informed consent. A needle will be placed with fluoroscopic (x-ray) guidance into the lumbar spine into the fibrous fluidcontaining sac that contains the lumbar nerve roots. Fluid may bewithdrawn (if necessary) for routine laboratory tests and then myelogram contrast (x-ray dye) will be injected. Radiographs will be taken and thenyou will have a CT of the area, within an hour or two of the myelogram.
You will then be monitored for potential complications in the hospital untilyou are discharged, usually about 4 hours after the procedure. You will beable to eat and drink as well as use the bathroom while in the hospital afterthe procedure.
Most complications of myelograms are rare (except for spinal headache) and the procedure is very safe. You need to know the potential 1. BLEEDING. As with all needle procedures, bleeding can occur. As long as you have no bleeding tendency and are not on any blood thinners such asCoumadin, bleeding complications are extremely rare. However, patientshave had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after needle procedures likemyelograms.
2. INFECTION. Any needle passing through the skin can introduce infection which in myelography would be meningitis. This is an extremely rarecomplication and sterile technique will be used.
3. SEIZURE. The injected contrast is absorbed around your brain in the first day and can be irritative. Some patients will complain of a mild headache,for which your nurse will give you pain medicine if necessary. It can alsobring on seizures, even in patients with no history of seizures/epi1epsy.
This is very rare complication, but is the reason that you will be monitored in the hospital for a few hours. Valium, which will often be given to youorally prior to the procedure, will reduce the tendency of the brain to have a seizure as well as be a mild sedative. You should not be currently takingany medications that may make seizure more likely, particularlyantidepressants (Paxil, Prozak, Zoloft, Elavil etc.). Typicallyantidepressants are held for 2 days before and 2 days after the procedurebut at times exceptions are made, depending on the antidepressant. Elavilmust always be held before and after the procedure. Patients with knownepilepsy taking anti-seizure medication, MAY have a myelogram but mustbe aware of the potential risk of inducing a seizure. An IV catheter(Heparin Lock) may be established prior to the procedure in patients felt tobe at high risk for seizure.
4. SPINAL HEADACHE. This is a common complication. It may occur if the small hole in the fibrous sac does not close after the needle puncture.
The fluid inside can then leak out, and when severe, the brain loses thecushioning effect of the fluid which causes a severe headache when you sit orstand. This occurs in up to 30-50% of patients that have a lumbar punctureof any kind including myelogram. They occur typically about 2-3 days,after the procedure and are positional, they come on when you sit or standand go away when you lie down. It is important that you follow instructions and stay at bedrest getting up only to go to the bathroom for afull 24 hrs and drink plenty of fluids after the procedure. That is importantto allow the small hole in the sac to heal. If you develop a spinal headache,it is OK to treat yourself. As long as you do not feel ill, have no fever, andthe headache goes away when you lie down, you may treat yourself withanother 24 hrs of bed rest with bathroom privileges while drinking plentyof fluids. This almost always works. If it does not, contact the radiologistwho performed the procedure or your referring physician, and a procedurecan be performed in the hospital that has a very high success rate in treating spinal headaches. This procedure is done in around 1% or less of patientsafter a myelogram, and is an epidural blood patch.
If you have any questions, please feel free to ask the physician performing the procedure prior to signing the consent form.
WHO monographs on selected medicinal plants (detail) VOLUME 1, World Health Organization Geneva 1999 http://whqlibdoc.who.int/publications/1999/9241545178.pdf WHO monographs on selected medicinal plants Definition Herba Echinaceae Purpureae consists of the fresh or dried aerial parts of Echinacea purpurea (L.) Moench harvested in full bloom (Asteraceae) ( 1 ). Synonyms Brau