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PubMed1992

A simple method of estimating cerebrospinal fluid pressure during lumbar puncture.

It is often difficult to measure cerebrospinal fluid (CSF) pressure in children. CSF flow through a spinal needle is described by the equation: Flow = pressure/(needle constant x relative viscosity). Thus, CSF flow rate during lumbar puncture can be used to estimate CSF pressure. Because the viscosity of CSF is approximately the same as that of normal saline, 0.9% NaCl was used to model CSF flow in vitro. Flow of saline through various spinal needles was measured as pressure and temperature were varied to determine needle constants and variation in viscosity with temperature. Counting periods for which the number of drops counted equals the pressure (in centimeters of H2O) then were determined for each needle size. At patient temperatures less than 40 degrees C, counting periods were calculated at 21, 39, and 12 seconds, for 22-gauge 1.5-inch, 22-gauge 3.5-inch, and 20-gauge 3.5-inch spinal needles, respectively. Viscosity decreased slightly above 40 degrees C, and counting periods became 20, 37, and 11 seconds. Finally, the method was tested prospectively in 12 patients by comparing drop count (over the calculated counting period) to manometric pressure measurement. Drop counts were within 15% of manometric pressure in all patients. This method allows simple and rapid estimation of CSF pressure during lumbar puncture.

Cerebrospinal Fluid Pressure↗
PubMed2005

Clearing of red blood cells in lumbar puncture does not rule out ruptured aneurysm in patients with suspected subarachnoid hemorrhage but negative head CT findings.

BACKGROUND AND PURPOSE: In evaluating the results of lumbar puncture (LP), a decrease in the number of red blood cells (RBCs)/mm3 between the first and fourth tubes collected (clearing) has often been assumed to indicate a traumatic puncture rather than the presence of subarachnoid hemorrhage (SAH). We tested the hypothesis that, in the setting of severe headache, CSF clearing coupled with an unremarkable unenhanced CT scan was negatively predictive of the presence of aneurysm and could be used to reduce the need for conventional arteriography. METHODS: Cerebral angiography was performed to evaluate suspected SAH in 123 consecutive patients over 2 years at a university teaching hospital. Records of these patients were reviewed. Among the subset without SAH on CT scan, LP results were evaluated for clearing. Clearing was arbitrarily defined as a 25% reduction in RBCs between the first and fourth tubes. This subset's records were also reviewed for the presence of aneurysm at cerebral angiography or at follow-up 6 weeks later. Data were analyzed for correlation between clearing and aneurysm. RESULTS: Of the 123 patients whose records were reviewed, 22 did not show an SAH on CT scan. Of those 22 patients, eight had aneurysm at angiography and 14 did not. Clinical diagnoses in the other 14 included trauma, herpes meningitis, sickle cell disease, and cocaine use. CSF clearing was noted in 25% of those with an aneurysm (two of 8) and 21% of those without an aneurysm (three of 14). In the two cases with aneurysms, RBCs cleared from 3550 to 2550 (-28%) and from 24,686 to 17,842 (-28%), respectively. In the remaining six cases with aneurysms, RBCs increased a mean of 1370% between the first and fourth tubes (range, -22% to 7700%). Two of these six had a reduction that did not meet our criteria for clearing (-22% and -5.3%, respectively). In the 14 cases without aneurysms, RBCs increased a mean of 70% between the first and fourth tubes (range, -99% to 895%). In addition to the three of these 14 that met our criteria for clearing (-99%, -99%, and -43%), four cases had a reduction that did not (range, -0.7% to -14%). CONCLUSION: A 25% reduction in RBC concentration between the first and fourth tubes of CSF in patients with suspected SAH but negative CT findings occurs even in cases of ruptured aneurysms. Formal evaluation for the presence of an aneurysm is still necessary in this scenario.

Aneurysm, Ruptured↗
PubMedDate not supplied

Sprotte needle for obstetric anesthesia: decreased incidence of post dural puncture headache.

BACKGROUND AND OBJECTIVES: Reports have emphasized the importance of spinal needle tip configuration in the development of post dural puncture headache (PDPH). METHODS: Charts from 366 consecutive obstetric patients receiving spinal anesthesia for labor, cesarean delivery, postpartum surgical procedures, or postpartum tubal ligations were reviewed retrospectively for evidence of PDPH in the five days after dural puncture. Spinal anesthesia was administered to these patients using 25-gauge Quincke (n = 74), 26-gauge Quincke (n = 160), or 24-gauge Sprotte (n = 132) spinal needles. RESULTS: The groups were well matched demographically. The incidence of PDPH in the three groups was 9%, 8%, and 1.5%, respectively. Half of the patients developing PDPH in each group were treated with an epidural blood patch. CONCLUSIONS: Our data indicate that the Sprotte spinal needle, with its non-cutting tip, results in a significantly lower (p less than 0.05) incidence of PDPH than Quincke cutting-tip needles of smaller gauge.

Anesthesia, Obstetrical↗
PubMedDate not supplied

Bilateral subdural hematomas after dural puncture: delayed diagnosis after false negative computed tomography scan without contrast.

BACKGROUND. Dural puncture secondary to spinal anesthesia or unintentional dural puncture during attempted epidural anesthesia can lead to headaches complicated by bilateral subdural hematomas. Routine computed tomography scan may not elucidate bilateral subdural hematomas in the isodense phase. CONCLUSION. Computed tomography scans with contrast media or magnetic resonance imaging may be necessary to diagnose bilateral subdural hematomas.

Adolescent↗
PubMed2005

Post-dural puncture arm and upper back pain--a report of two cases.

The typical postdural puncture headache manifests as postural frontal, frontotemporal, or occipital headache, which is worsened by ambulation, and improved by decubitus. Accompanying symptoms are nausea, vomiting, and neck stiffness. Various rare presentations after dural puncture, such as upper back pain, arm pain, thoracic pain, bowel and bladder dysfunction have been sparsely reported. We report two cases who sustained arm and upper back pain after spinal anesthesia, and epidural blood patch gave them a complete relief of the symptoms.

Adult↗
PubMed2005

[Reform and application of the vas deferens puncture tube needle via skin].

The article gives a detailed introduction of the process of marking flat tube needle for vas deferens puncture and a brief explanation of its application. This kind of tube needle can be easily made of readily available material, convenient to be cleaned and sterilized, with high success rate of puncturing and good effect. Other tube needles can be made by imitating it.

Equipment Design↗
PubMed2006

Prolonged post-dural puncture headache in a patient with a renal transplant.

Data regarding the duration and severity of postdural puncture headache in patients with probable causes for impairment of cerebral autoregulation and altered rate of cerebrospinal fluid formation are rare. We present an interesting case of a patient with long-standing severe hypertension and resultant end-stage renal disease status postrenal transplant who developed a prolonged postdural puncture headache of mild severity. Its presentation and possible pathophysiological mechanisms are discussed.

Adult↗
PubMedDate not supplied

[CT-stereotaxic punctures, aspiration and drainage of deep space-occupying processes in the brain (cystic tumors, hematomas and abscesses)].

The article analyses the clinical material concerning 68 patients with various deeply-seated space-occupying processes of the brain (cystic tumors, multiple abscesses, intracerebral hematomas) which were subjected to stereotaxic aspiration on the basis of the findings of computed tomography (CT-stereotaxic punctures). A significant and immediate effect with rapid regression of local and general cerebral symptoms was recorded in 38 patients with cystic intracerebral tumors and craniopharyngiomas. All the patients tolerated the operation well and in none of them were complications encountered. The precision, reliability and safety of CT-stereotaxic punctures--is the basis for such operations as intra-tissue beta-therapy of craniopharyngiomas with radiocolloids, evacuation of intracerebral hematomas, and drainage of multiple brain abscesses. Being an obvious palliative surgical measure, CT-stereotaxic aspiration of deeply-seated cystic tumors is a method of choice in cases in which a direct operation is contraindicated and in patients who are in a grave condition.

Adolescent↗
PubMed2006

Direct carotid puncture for the endovascular treatment of anterior circulation aneurysms.

We report the usefulness of Guglielmi detachable coil (GDC) embolization by direct carotid puncture for anterior circulation aneurysms. For all 27 patients, GDC embolization by direct carotid puncture was safely performed by using a 5F sheath introducer 5 cm long and a Tracker-38 catheter. Neurologic deficits and hemorrhage were not found in any patient during the follow-up period. If the transfemoral approach cannot be applied, GDC embolization should be considered as an alternative method.

Aged↗
PubMed2006

Prevention strategy for post dural puncture headache.

We report the anesthetic management of a parturient after an unintentional dural puncture while performing epidural anaesthesia for caesarean section and the strategy to prevent postdural puncture headache (PDPH). We injected the cerebrospinal fluid (CSF) back into the subarachnoid space and then administered intrathecal 1.5 mL 0.5% hyperbaric bupivacaine and fentanyl 20 microg to maintain CSF volume via epidural needle. The epidural catheter was inserted following re-identification of the epidural space for possible epidural top-up requirement and postoperative pain relief. After adding 3 mL of 0.5% isobaric bupivacaine via epidural catheter, sensory block level reached at T4 bilaterally. No PDPH was observed.

Adult↗
PubMedDate not supplied

[How to avoid failure and complications in guided punctures].

The author discusses some actual procedures associated with diagnostic and therapeutic interventions using ultrasonography. Based on his own experience from practice, documented in tables with brief comments (attached to the paper) and with regard to data in the literature, he draws attention to some facts (technique of puncture, selection of instruments, local anaesthesia, method of drainage) which may to a varying extent influence the results of aimed puncture or cause possible complications.

Drainage↗
PubMed1991

[Experience with the management of pyogenic liver abscesses by percutaneous transhepatic puncture and drainage].

The authors treated forty-two patients with liver abscesses guided by computer tomography or ultrasound percutaneous transhepatic puncture or drainage from January 1 1983, to 1989 December 31. Closed aspiration or drainage was done in 42 patients altogether 56 times. Three patients died (3/42 = 7.2%), postdrainage complications happened in 9 cases (9/42 = 21.4). Operative intervention was necessary in 11 patient after the percutaneous procedure (11/42 = 26.2%). The authors wrote about the technics particularly of the percutaneous puncture or drainage. The authors are considering the method as an effective treatment for pyogenic liver abscesses if the personal and technical circumstances are given.

Drainage↗
PubMed1976

Complications of arterial puncture in anticoagulated patients.

Thirteen patients who were receiving heparin in therapeutic doses had complications after femoral or brachial arterial puncture as follows: hematomas resulting in skin slough or infection in two, neuropathies of the median nerve in two and of the femoral nerve in two, and ischemia of the forearm muscles in seven. Since arterial puncture to determine blood gases in patients anticoagulated for pulmonary emboli can be dangerous, alternate means to establish the diagnosis are recommended. Early recognition and treatment of complications are essential.

Adult↗
PubMed1991

[Inner ear deafness following lumbar puncture. A complication requiring patient education?].

Deafness after lumbar puncture has been reported occasionally. Until now this complication has been regarded as spontaneously reversible, but a more recent publication of three cases of irreversible hearing loss possibly caused by lumbar puncture casts doubt on this. It has been proposed that this complication should be included in the pre-operative information given to patients, but we oppose this proposal.

Deafness↗
PubMedDate not supplied

Post dural puncture headache after lumbar sympathetic block: a report of two cases.

Dural puncture during lumbar sympathetic block (LSB) is a recognized but apparently uncommon complication. Interestingly, post dural puncture headache (PDPH) has not been reported as a complication of LSB. The authors report two cases of PDPH after LSB. In the first case an attempt to treat the PDPH with an epidural blood patch failed. In the second case the patient developed PDPH and a subdural block during separate LSBs. Possible anatomic explanations for these complications are discussed.

Adolescent↗
PubMed1990

[Post-puncture headache and patients' personality characteristics].

Diagnostic lumbar punctures were performed in 60 patients suffering from different organic diseases of the central and peripheral nervous systems. Out of 60 persons, 30 developed postpuncture headache. Comparison of the personality traits in patients with and without postpuncture headache, made according to the MMPI technique, has shown significant differences in scales 1, 3 and 7 of the MMPI profile (scales of hypochondria, hysteria and psychasthenia). A conclusion is drawn that the patients' personality traits are of undoubtful importance in the pathogenesis of postpuncture headache. This circumstance should be taken into consideration in carrying out proper psychological and medicamentous preparation of the patients before lumbar punctures.

Adolescent↗
PubMedDate not supplied

Continuous spinal anesthesia and post dural puncture headache: a retrospective study.

Continuous spinal anesthesia (CSA) fell into disuse because of a presumed high incidence of post dural puncture headache (PDPH). A careful retrospective study of 226 continuous spinal anesthetics administered for a variety of surgical (not obstetric) procedures was carried out and indicated that none of the patients developed PDPH. While 62% of the patients were older than 60 years of age, a group with a low incidence of PDPH, it was expected that some of the younger patients would develop this complication, especially since 94% of the dural punctures were carried out with 17- and 18-gauge needles. This study also revealed only a 12% incidence of hypotension, an impressive finding because 64% of the patients were considered ASA III or IV. There were no other intraoperative or postoperative complications or deaths due to CSA. This retrospective study indicates that CSA, properly carried out with 17- and 18-gauge needles, is not necessarily associated with a high incidence of PDPH; and in view of its low morbidity and mortality, CSA is particularly useful and safe in the poor-risk elderly patient. This study also raises the question as to whether there is a need for the recently developed (and expensive) microcatheters that fit through very small-bore needles.

Adult↗