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Spinal Puncture

Lumbar Puncture


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]
  • 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]
  • Sensitivity decays rapidly within days, so patients who do not present immediately, or who have to wait for computed tomography, are less likely to be identified, and the importance of a subsequent lumbar puncture cannot be overstated.[ncbi.nlm.nih.gov]
  • To the best of our knowledge, this case is the third oldest patient, whose symptoms presented relatively early after the initial LP. He was successfully treated by surgery. Pathologic diagnosis revealed an epidermoid cyst.[ncbi.nlm.nih.gov]
Intravenous Administration
  • ., Bolte RG Risks of intravenous administration of hypotonic fluids for pediatric patients in ED and prehospital settings: let's remove the handle from the pump. Am J Emerg Med. 2000 ;18: 269 - 270.[doi.org]
  • . , Bolte RG Risks of intravenous administration of hypotonic fluids for pediatric patients in ED and prehospital settings: let's remove the handle from the pump . Am J Emerg Med. 2000 ;18: 269 - 270 .[jic.sagepub.com]
Prolonged Immobilization
  • immobilization or restraint, while traumatic LPs can be difficult to interpret, resulting in diagnostic uncertainty, prolonged hospital courses, additional procedures, and potential iatrogenic complications. 5 - 8 Ultrasound has been suggested to improve[doi.org]
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]
  • 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]
  • 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]
  • Guest over a year ago Jan 2007 i got my Tap done in the ER. since then the lower back pain set in. so i got, 3 MRI's done, they found nothing.[steadyhealth.com]
  • 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]
  • Possible adverse effects from a botched spinal tap include nerve and tissue damage, chronic low back pain, implantation of epidermal tumours, infections, internal bleeding and blood clots along the spine.[healthy.net]

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]
  • Young infants commonly require lumbar puncture as a part of the routine workup for fever without a source. This is due to higher rates of meningitis than in older persons.[en.wikipedia.org]
  • Abnormal results A lumbar puncture is sometimes used as part of a diagnostic cancer workup.[encyclopedia.com]
  • 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]
Xanthochromia
  • Xanthochromia revisited: a reevaluation of lumbar puncture and ct scanning in the diagnosis of subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 1988 ; 51 : 342 – 4.[doi.org]
Hypocapnia
  • […] occur the presence of cancer of the CNS, multiple sclerosis, heritable mitochondrial disease, low blood pressure, low serum phosphorus, respiratory alkalosis, idiopathic seizures, traumatic brain injury, cerebral ischemia, brain abscess, hydrocephalus, hypocapnia[en.wikipedia.org]
Gram-Positive Bacteria
  • Gram staining may demonstrate gram positive bacteria in bacterial meningitis. Microbiological culture is the gold standard for detecting bacterial meningitis. Bacteria, fungi, and viruses can all be cultured by using different techniques.[en.wikipedia.org]

Treatment

  • Treatments included the horizontal position along with analgesics, fluid therapy, and corticosteroids. The usefulness of blood patch remains controversial.[ncbi.nlm.nih.gov]
  • The benefits of conservative treatment by lumbar spinal puncture are discussed.[ncbi.nlm.nih.gov]
  • Treatment with hydrocortisone plus conventional treatment showed better VAS scores at six, 24 and 48 hours when compared with conventional treatment alone and also when compared with placebo.[cochrane.org]
  • Treatment consists of analgesics, hydration and attempts to restore normal cerebrospinal fluid pressure.[ncbi.nlm.nih.gov]
  • The technique, complications, contraindications, and treatment of the complications are reviewed.[doi.org]

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]
  • Nordland Hospital Bodø Treatment and prognosis Post-dural puncture headache has in principle a self-limiting course.[tidsskriftet.no]
  • 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]
  • 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]
  • Transient neurologic symptoms: etiology, risk factors, and management. Regional anesthesia and pain medicine, 27(6), 581-586. Richardson, W.S., Wilson, M.C., Nishikawa, J., & Hayward, R.S. (1995).[profinf.net]

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]
  • Neurology 42 : 54–59 47 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[doi.org]
  • 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.[doi.org]
Sex distribution
Age distribution

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]
  • Better understanding of the pathophysiology and ongoing clinical trials will hopefully help inform treatment strategies over the next few years.[ncbi.nlm.nih.gov]

Prevention

  • Prevention of postlumbar puncture headache consists largely in attempts to avoid the development of the pressure differential between that of the cerebrospinal fluid and intracranial venous pressure.[ncbi.nlm.nih.gov]
  • 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.[doi.org]
  • Although still a commonly performed procedure in the outpatient setting, effective vaccines to prevent invasive infection due to Streptococcus pneumoniae and Haemophilus influenzae type b have greatly reduced pediatric bacterial meningitis rates due to[ncbi.nlm.nih.gov]

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