Presentation
In this review, technical details of these procedures are described and examples of common and uncommon postprocedure appearances on imaging are presented. [ncbi.nlm.nih.gov]
In spinal subdural hematomas, patients present with severe low back, radicular pain, sensory loss or paraparesis hours to days post LP. [meds.queensu.ca]
Overview Snapshot A 59-year-old man presents to the emergency department with altered mental status. The patient is accompanied by his wife who says that the patient had a fever and headache for the past few days. [step1.medbullets.com]
Musculoskeletal
- Back Pain
A 15-year-old boy developed back pain and sciatica after a minor trauma. Magnetic resonance imaging revealed lumbar spinal subdural hematoma. [ncbi.nlm.nih.gov]
It shouldn't be painful, but you may have a headache and some back pain for a few days. It's carried out in hospital by a doctor or specialist nurse. [nhs.uk]
- Low Back Pain
Complications are infrequent, except for headaches and low back pain, but can be severe. Analysis of the cerebrospinal fluid must include a cell count and determination of the glucose and protein concentrations. [ncbi.nlm.nih.gov]
SLIDESHOW Low Back Pain: Symptoms, Causes, Treatment, Relief See Slideshow Medically Reviewed on 12/13/2019 References Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015. [medicinenet.com]
Workup
CT or MR imaging as part of the diagnostic workup may reveal expected or unexpected findings which may explain these symptoms. Small foci of gas within the spinal canal or intracranial compartment are common but are usually self-limited. [ncbi.nlm.nih.gov]
When babies develop a fever high enough or abrupt enough to cause a seizure, frightened parents often rush them to the emergency room, where their workup frequently includes a spinal tap to rule out bacterial meningitis. [childrenshospital.org]
Abnormal results A lumbar puncture is sometimes used as part of a diagnostic cancer workup. [encyclopedia.com]
CSF containing less than 10 red blood cells (RBCs)/mm³ constitutes a "negative" tap in the context of a workup for subarachnoid hemorrhage, for example. [en.wikipedia.org]
Young infants commonly require lumbar puncture as a part of the routine workup for fever without a source, as they have a much higher risk of meningitis than older persons and do not reliably show signs of meningeal irritation. [house.wikia.com]
Treatment
Sandesc D, Lupei M ‐ I, Sirbu C. et al Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg 2005 56 265–269. [ PubMed ] [ncbi.nlm.nih.gov]
The technique, complications, contraindications, and treatment of the complications are reviewed. [oadoi.org]
Medical treatment for PLPH [ Time Frame: 15 days ] Patient will be asked by phone by a blinded research assistant if they received a medical treatment for their PLPH (eg. analgesics) Medical treatment for backache [ Time Frame: 8 days ] Patient will be [clinicaltrials.gov]
Prognosis
Spinal hematomas typically present with severe and localized back pain, rapidly progressive myelopathy and a poor prognosis for functional recovery unless immediate decompression is performed. [ncbi.nlm.nih.gov]
Persistently elevated CSF cryptococcal antigen in HIV-infected patients carries a poor prognosis and indicates ongoing production of viable Cryptococcus neoformans in tissue. [doi.org]
Post-dural puncture headache: Part I, Prevention, Management, and Prognosis. Headache: The Journal of Head and Face Pain, 50, 1144-1152. doi: 10.1111/j.1526-4610.2010.01758.x. Bezov, D., Ashina, S., & Lipton, R. (2010). [profinf.net]
© Nordland Hospital Bodø Treatment and prognosis Post-dural puncture headache has in principle a self-limiting course. [tidsskriftet.no]
Changes and Fall Risk in MCI and Dementia Gilles Allali & Joe Verghese Current Treatment Options in Neurology (2017) Finger tapping and verbal fluency post-tap test improvement in INPH: its value in differential diagnosis and shunt-treatment outcomes prognosis [nature.com]
Etiology
It is an essential part of establishing the etiology (cause) of persistent headache, fever, or other problems such as weakness and numbness in the legs. It may also be used to assess the tumour severity. [aidsmap.com]
(Viral meningitis caused by HSV-1) Introduction Lumbar puncture (LP) is a procedure where a spinal needle is advanced into the subarachnoid space in order to collect cerebral spinal fluid (CSF) the LP can allow the physician to determine the etiology [step1.medbullets.com]
Despite a large number of hypotheses and publications over the past decade, the etiology of IIH is still unknown. There continues to be no evidence-based consensus or formal guidelines regarding management and treatment of the disease. [ncbi.nlm.nih.gov]
[…] studies on the CSF List complications Recognize special considerations in select patients Indications for lumbar puncture Signs and symptoms concerning for meningitis (bacterial, viral, fungal, and tubercular) Altered mental status without other clear etiology [cdemcurriculum.com]
Epidemiology
Clinical epidemiological study of 171 cases of cryptococcosis. Clin. Infect. Dis. 18 : 369 -380. Wu, G., R. A. Vilchez, B. Eidelman, J. Fung, R. Kormos, and S. Kusne. 2002. [doi.org]
Trenkwalder C et al. (1995) Starnberg trial on epidemiology of Parkinsonism and hypertension in the elderly: prevalence of Parkinson's disease and related disorders assessed by a door-to-door survey of inhabitants older than 65 years. [nature.com]
Epidemiology of cryptococcosis in France: a 9 year survey (1985-1993). Clin Infect Dis 1996;23(1):82-90. 5. Dismukes WE. Cryptococcal meningitis in AIDS. J Infect Dis 1998;157:624-628. 6. Hajjeh RA, Conn LA, Stephen DS, Baughman W, Hamill R, et al. [ijmm.org]
Epidemiology and clinical management of meningococcal disease in west Gloucestershire: retrospective, population based study. Br Med J. 1997 ;315: 774 - 779. [jic.sagepub.com]
Pathophysiology
In many reports, LP is temporally strongly associated with this event of herniation and is most likely causative based on pathophysiologic arguments. [ncbi.nlm.nih.gov]
Patients with neurologic symptoms are approached in a stepwise manner termed the neurologic method, which consists of the following: Identifying the anatomic location of the lesion or lesions causing symptoms Identifying the pathophysiology involved Generating [merckmanuals.com]
From a pathophysiological viewpoint, the post LP headache occurs because of the tear in the dura mater caused by the LP needle. [meds.queensu.ca]
Prevention
In terms of the prevention and treatment of post-LP headaches, both are equally important in management. Following, is a discussion of which techniques and preventative measures are evidence based and which are not. [rebelem.com]
Pencil-point needle in prevention of postspinal headache. JAMA. 1951; 147 657-658 3 Sprotte G, Schedel R, Pajunk H. Eine "atraumatische" Universalkanule fur einzeitige Regionalanasthesien. [oadoi.org]
[…] headache and consider resting and lying flat for first 12 hours to help prevent possible headaches while things heal Editors & Reviewers Editors: Anthony J. [ebmconsult.com]