BACKGROUND: The process of measuring intracranial pressure (ICP) can be accomplished using a variety of monitors placed primarily either in the ventricles or brain parenchyma. OBJECTIVE: There is inadequate data to support the conclusion that ICP measured simultaneously from 2 different sites using 2 different devices produces similar findings in the same subject. The purpose of this study was to identify the correlation between simultaneous measurements from both an external ventricular drain (EVD) and an intraparenchymal monitor (IPM). METHODS: In this retrospective observational study, manual chart abstraction was used to obtain time-indexed ICP values during a period of 2 years from patients diagnosed with severe traumatic brain injury who had received simultaneous EVD and IPM placement. RESULTS: When all time points were compared, the correlation between EVD and IPM was strong (r2 = 0.6955). However, when limiting the ICP values to be <20 or <25 in either the EVD or the IPM, the correlation was noted to be weaker (r2 = 0.3576 and r2 = 0.4232, respectively). CONCLUSION: There is inadequate evidence to support that intraparenchymal ICP values can be treated in a similar manner to ICP values obtained from an EVD. ABBREVIATIONS: CSF, cerebrospinal fluid EVD, external ventricular drain ICP, intracranial pressure IPM, intraparenchymal monitor TBI, traumatic brain injury
Environmental factors are thought to be critical in the initiation and perpetuation of multiple sclerosis disease activity.We describe the case of a woman in her late 30s with a diagnosis of relapsing-remitting multiple sclerosis, who continued to accumulate neurological disability despite long-term natalizumab treatment. The patient continued to have visual symptoms, left leg weakness, and gait instability. In addition, she subacutely developed an encephalopathy. Our investigations revealed that the patient had a long-standing history of chewing on toilet bowl deodorizing cakes. The main ingredient in this product is 99.9% paradichlorobenzene, which is also used in mothballs.This case illustrates that environmental causes for neurological deterioration should be investigated in patients with multiple sclerosis who display a rapidly progressive disease course and in whom potent pharmacotherapies fail. One possible cause is the ingestion of paradichlorobenzene-containing mothballs and toilet cleaners.
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