Lumbar Puncture Test in Normal Pressure Hydrocephalus: Does the Volume of CSF Removed Affect the Response to Tap?

Abstract

BACKGROUND AND PURPOSE:There is limited evidence to support the use of high-volume lumbar taps over lower-volume taps in the diagnosis of normal pressure hydrocephalus. The purpose of this study is to detect whether the volume of CSF removed from patients undergoing high-volume diagnostic lumbar tap test for normal pressure hydrocephalus is significantly associated with post-lumbar tap gait performance.

Cerebrospinal fluid closing pressure-guided tap test for the diagnosis of idiopathic normal pressure hydrocephalus: A descriptive cross-sectional study

“…The optimal volume of CSF that should be extracted during the lumbar puncture for tap test has not been determined, much variation exists on the recommended amount, and there is no significant association between the volume of CSF removed and gait outcomes when extracted volume falls within the 28–50 mL range. [ 16 ] Later, the test was enhanced by increasing the amount of fluid extracted, given that extracting less than 25 mL had a lower sensitivity. [ 2 , 11 ] Wikkelso et al .…”

“…[ 2 , 4 , 7 , 8 , 13 ] Symptoms, imaging, and neurologic tests have a positive predictive value (PPV) of 50–61% which suggests a moderate improvement after shunt surgery. [ 8 , 9 , 16 ] Because the prognostic value of imaging is limited, other tests are needed to increase the probability of identifying patients with iNPH who will respond to shunt surgery. [ 11 ] The only effective treatment is a CSF shunt that derives fluid to either the peritoneum, right atrium or pleura and most patients (60–80%) improve after surgery.…”

Percutaneous Fenestration of a Spinal Arachnoid Web Using an Intrathecal Catheter: Effect on Cerebrospinal Fluid Flow and Clinical Status

“…The lumbar drainage catheter was clearly visible, with its tip terminating at the level of the second thoracic vertebra. We continued to drain CSF at a rate of 10 mL/hour for 72 hours 15,16 while simultaneously undertaking serial examinations on a daily basis (see Table 1). Overall, we drained an average of 200e250 mL of CSF per day and removed the catheter on the third day without problems or complications.…”

Normal Pressure Hydrocephalus with Primary Presentation of Psychiatric Disturbance?

“…The association between the volume of CSF removed and the response to a tap test is controversial in the literature. 2,3 However, diversion of a large volume of CSF during a tap test has been general knowledge for a long time. 4 In my opinion, in light of the presentation of this case, the significance of the amount of CSF drainage while interpreting the postdiversion response and making the diagnosis of NPH should have been described more specifically.…”