A 1969 study of 30 patients with increased ICP who deteriorated after LP attempted to identify the clinical features of patients who were at greatest risk for this complication [ 59 ]. The following findings were noted: 73 percent had focal findings on neurologic examination (including dysphagia, hemiparesis, and cranial nerve palsies); 30 percent had documented papilledema prior to the LP; and 30 percent had evidence of increased ICP on plain skull films (erosion of the posterior clinoid processes). Deterioration occurred immediately in one-half of the patients, with the remainder declining within 12 hours.
In hemodynamically compromised patients, AF must be treated emergently with synchronized electric cardioversion. There are no controlled studies available to suggest recommendations regarding anticoagulation in these patients. In a nonrandomized trial of 437 patients (532 instances of cardioversion), 20 the incidence of an embolic event was percent in the group receiving anticoagulant therapy, compared with percent in the group not receiving anticoagulant therapy. These results are impressive because the number of patients with congestive heart failure, hypertension and rheumatic heart disease was greater in the anticoagulation group than in the group not receiving anticoagulation.
The Advisory Committee on Immunization Practices (ACIP) recommendations and package inserts for vaccines provide information on contraindications and precautions related to vaccines. Contraindications are conditions that increase chances of a serious adverse reaction in vaccine recipients and the vaccine should not be administered when a contraindication is present. Precautions should be reviewed for potential risks and benefits for vaccine recipient. For a person with a severe allergy to latex, ., anaphylaxis, vaccines supplied in vials or syringes that contain natural rubber latex should not be administered unless the benefit of vaccination clearly outweighs the risk for a potential allergic reaction. For latex allergies other than anaphylaxis, vaccines supplied in vials or syringes that contain dry, natural rubber or natural rubber latex may be administered.