Spinal puncture: Difference between revisions

From Citizendium
Jump to navigation Jump to search
imported>Robert Badgett
imported>Robert Badgett
Line 19: Line 19:
* The position of the lower extremities does not matter.<ref name="pmid11136140">{{cite journal| author=Abbrescia KL, Brabson TA, Dalsey WC, Kelly JJ, Kaplan JL, Young TM et al.| title=The effect of lower-extremity position on cerebrospinal fluid pressures. | journal=Acad Emerg Med | year= 2001 | volume= 8 | issue= 1 | pages= 8-12 | pmid=11136140  
* The position of the lower extremities does not matter.<ref name="pmid11136140">{{cite journal| author=Abbrescia KL, Brabson TA, Dalsey WC, Kelly JJ, Kaplan JL, Young TM et al.| title=The effect of lower-extremity position on cerebrospinal fluid pressures. | journal=Acad Emerg Med | year= 2001 | volume= 8 | issue= 1 | pages= 8-12 | pmid=11136140  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11136140 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11136140 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
===Laboratory tests===
* For [[Cryptococcus neoformans]]
** India ink smear, cryptococcal antigen, fungal culture
* For [[Mycobacterium tuberculosis]]
** Acid-fast smear, nucleic acid amplification test (NAAT)<ref name="pmid14522262">{{cite journal| author=Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM| title=Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. | journal=Lancet Infect Dis | year= 2003 | volume= 3 | issue= 10 | pages= 633-43 | pmid=14522262
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14522262 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> (polymerase chain reaction)


==References==
==References==
<references/>
<references/>

Revision as of 19:56, 20 November 2009

This article is a stub and thus not approved.
 Main Article
 Discussion
Related Articles  [?]
Bibliography  [?]
External Links  [?]
Citable Version  [?]
 
https://en.citizendium.org/wiki/index.php?title=Spinal_puncture&printable=yes
This editable Main Article is under development and subject to a disclaimer.

A spinal puncture, also called a spinal tap, lumbar puncture, or LP is "tapping of the subarachnoid space in the lumbar region, usually between the third and fourth lumbar vertebrae.[1][2][3][4]

Procedure

Use of an 'atraumatic needle' may reduce the chance of headache, although this needle is more difficult to use and may increase the number attempts needed before successful puncture.[2] Reinsertion of the stylet before needle removal decreases headache.[2]

Measurement of CSF pressure

The normal opening pressure is 6 to 18 cm of H2O or 0.4 to 1.3 cm Hg (mercury is 13.6 times more dense than water).[2] To accurately measure the opening pressure of the cerebrospinal fluid:

  • The patient should be laying (not sitting)[5][6] Sitting may increase the pressure by 40 cm H2O.[7] In the sitting position, CSF pressure ranges from 32 to 63 cm H2O with a mean of 49 cm H2O.[8]
  • The patient's neck should be relaxed as fully flexing the neck ('chin on chest') can raise pressure by 12 cm H2O[9][10] This may be due to the patient inadvertently performing Queckenstedt's maneuver or similar. Flexing the neck to only 30° may not matter.[11]
  • The position of the lower extremities does not matter.[11]


Laboratory tests

References

  1. ↑ Anonymous (2024), Spinal puncture (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ 2.0 2.1 2.2 2.3 Straus SE, Thorpe KE, Holroyd-Leduc J (October 2006). "How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?". JAMA 296 (16): 2012–22. DOI:10.1001/jama.296.16.2012. PMID 17062865. Research Blogging. Cite error: Invalid <ref> tag; name "pmid17062865" defined multiple times with different content
  3. ↑ Ellenby MS, Tegtmeyer K, Lai S, Braner DA (September 2006). "Videos in clinical medicine. Lumbar puncture". N. Engl. J. Med. 355 (13): e12. DOI:10.1056/NEJMvcm054952. PMID 17005943. Research Blogging.
  4. ↑ Marton KI, Gean AD (1986). "The spinal tap: a new look at an old test.". Ann Intern Med 104 (6): 840-8. PMID 3518565.
  5. ↑ Becht FC (1920) Studies on the cerebrospinal fluid. Am J Physio 1920;51(1):1-125**
  6. ↑ Loman J, Myerson A, Goldman D. Effects of alterations in posture on the cerebrospinal fluid pressure. Arch Neurol Psych. 1934:1279-1295.**
  7. ↑ Magnaes B (1976). "Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes.". J Neurosurg 44 (6): 687-97. DOI:10.3171/jns.1976.44.6.0687. PMID 1271089. Research Blogging. **
  8. ↑ Magnaes B (1976). "Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point.". J Neurosurg 44 (6): 698-705. DOI:10.3171/jns.1976.44.6.0698. PMID 1271090. Research Blogging.
  9. ↑ Dinsmore J, Bacon RC, Hollway TE (1998). "The effect of increasing degrees of spinal flexion on cerebrospinal fluid pressure.". Anaesthesia 53 (5): 431-4. PMID 9659014.
  10. ↑ Deliyannakis E (1971). "Influence of the position of the head on the cerebrospinal fluid pressure. Variations of the Queckenstedt sign.". Mil Med 136 (4): 370-2. PMID 5005427. **
  11. ↑ 11.0 11.1 Abbrescia KL, Brabson TA, Dalsey WC, Kelly JJ, Kaplan JL, Young TM et al. (2001). "The effect of lower-extremity position on cerebrospinal fluid pressures.". Acad Emerg Med 8 (1): 8-12. PMID 11136140.
  12. ↑ Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM (2003). "Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis.". Lancet Infect Dis 3 (10): 633-43. PMID 14522262.
Retrieved from "https://citizendium.org/wiki/index.php?title=Spinal_puncture&oldid=498773"