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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 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 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.

after cranial, nasal, or spinal surgery These give rise to some of the most intractable low-pressure syndromes and must be investigated by radiologic and nuclide studies in order to establish the site of leakage Several such leaks in our experience have been intermittent, adding to the dif culty in diagnosis

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The effects of bacterial invasion of the pia-arachnoid, cerebrospinal subarachnoid space, ventricles, and ependyma are described in Chap 32 and summarized in Table 32-1 The point being made here is that these structures may also be involved in a number of noninfective processes, some of obscure origin Since the ventricular and subarachnoid spaces are in continuity, one would expect that a noxious agent entering any one part would extend throughout the CSF pathway Such is not always the case The lower spinal roots or spinal cord alone may be implicated in spinal arachnoiditis A similar process may affect the optic nerves and chiasm exclusively ( opticochiasmatic arachnoiditis, see below) This may be accompanied by a pachymeningitis, and the latter may also be restricted to the cervical dura, also discussed below A predominant localization to these basal or cervical structures may be apparent even in cases of diffuse cerebrospinal meningeal reactions, perhaps because of an uneven concentration of the noxious agent In other instances, the primary disease appears to have arisen in the dura, with extension only to the adjacent piaarachnoid In yet other instances, the ependyma of the aqueduct or fourth ventricle is primarily involved The mechanisms by which these meningeal reactions affect parenchymal structures (brain, cord, and nerve roots) are not fully understood The most obvious sequela is an obstruction to the ow of CSF in hydrocephalus; here, simple brotic narrowing of the CSF circulatory pathway is causative Progressive constriction of nerve roots and spinal cord, literally a strangulation of these structures, is another plausible mechanism, but it is dif cult to separate vascular factors from mechanical ones Since any toxic agent introduced into the subarachnoid space has free access, via VirchowRobin spaces, to the super cial parts of the brain and spinal cord, direct parenchymal injury may follow Perivascular reactions of subpial vessels, as in infectious processes, would be a plausible mechanism of injury to optic nerves and spinal cord, where long stretches of myelinated bers abut the pia Regional Arachnoiditis Arachnoiditis limited to the lumbosacral roots has followed ruptured discs, myelograms, and spinal surgery Usually, there is sciatica and chronic neuropathic pain in the back and lower extremities, but sensorimotor and re ex changes in the legs are variable The MRI shows irregularly enhancing roots and arachnoidal thickening; myelography discloses loculated pockets of imaging media (Fig 11-6) This condition is discussed further in Chap 11, under The Failed-Back Syndrome Another form of spinal arachnoiditis, in which both the spinal cord and roots are entrapped in thickened pia-arachnoid, sometimes with arachnoid-dural adhesions, is rare but well-known entity An account of this condition is included with the spinal cord diseases (see Chap 44) The etiologic factors have been singularly elusive although in the past it followed the instillation of iophendylate (Pantopaque) for myelography and corticosteroids (for pain or multiple sclerosis) and other irritative agents The condition may be accompanied by cranial basilar meningeal brosis with optic nerve involvement and hydrocephalus (see below), or it may occur in.

and it s something that you would immediately find out once you execute your WAD templates, since you would get either a warning or an error, but it s available in the SBC area and needs to be activated Under the 3x templates, you will find the final 70 template required That is the template that controls some components of the Information Broadcaster So, you have to expand Web Template (Format SAP BW 3x) to get this one The illustration shows the actual template required 0BROADCASTING_TEMPLATE70 Now, if you are not using the Information Broadcaster, you do not need this template, but depending on what you are accessing, you may run into a warning that this specific template is not active So, activate it here and be done with all of the SBC at once

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