When not to do a lumbar puncture.

Addy, D P

doi:10.1136/adc.62.9.873

Cited by 72 publications

(37 citation statements)

References 13 publications

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“…A substantial portion of the patients in our study developed life-threatening neurological signs of emerging brain stem herniation within min to h after lumbar puncture. Because of the temporal relationship and the documented ICP level in these patients, it is difficult to discard a possible causal relationship between the dural puncture and the brain stem symptoms as reported by many other investigators (11,31,32). Thus, there are strong indications suggesting that lumbar puncture in patients with intracranial hypertension is associated with a significant risk of lifethreatening complications and should be avoided.…”

Section: Fig 2 Mri Brain Scan Of Patient 4 (A) Before Start Of the mentioning

confidence: 98%

“…However, there is ample clinical experience that this procedure is potentially hazardous in patients with intracranial hypertension, because it may precipitate brain stem herniation (11,31,32). Still, most of our patients had been subjected to diagnostic lumbar punctures at the various emergency departments before evaluation by our team.…”

Section: Fig 2 Mri Brain Scan Of Patient 4 (A) Before Start Of the mentioning

confidence: 99%

“…The benefit contra the risk of performing lumbar dural puncture in severe cases of bacterial meningitis with suspicion of intracranial hypertension has been debated, because it may induce brain stem herniation and thus precipitate a lifethreatening situation (11,12).…”

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confidence: 99%

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Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis

Grände

Myhre

Nordström

et al. 2002

Acta Anaesthesiol Scand

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Background: Brain stem herniation due to raised intracranial pressure (ICP) is a common cause of mortality in severe bacterial meningitis, but continuous measurements of ICP and the effects of ICP-reducing therapy in these patients have, to our knowledge, not been described. Methods: During a four-year period, an ICP-monitoring device was implanted in patients admitted to our hospital with severe bacterial meningitis and suspected intracranial hypertension. ICP above 20 mmHg was treated using the Lund Concept, which includes antihypertensive therapy (b 1 -antagonist,a 2 -agonist), normalization of the plasma colloid osmotic pressure and the blood volume, and antistress therapy. Results: ICP above 20 mmHg was found in all 12 patients studied. It was effectively reduced in all but two patients, who died. Both patients had a low cerebral perfusion pressure (Ͻ10 mmHg), dilated pupils at start of therapy and were beyond recovery. Radiological signs of brain swelling were present in only five patients. Seven patients recovered fully, while mild audiological impairment was observed in two and minor neurological sequelae in one patient. Eight patients showed signs suggesting imminent brain stem herniation before start of ICP-reducing treatment, seven of whom had been subjected to diagnostic lum-

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Section: Fig 2 Mri Brain Scan Of Patient 4 (A) Before Start Of the mentioning

confidence: 98%

Section: Fig 2 Mri Brain Scan Of Patient 4 (A) Before Start Of the mentioning

confidence: 99%

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Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis

Grände

Myhre

Nordström

et al. 2002

Acta Anaesthesiol Scand

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“…CSF examination is essential to establish the diagnosis and to identify the etiological agent. CSF characteristics of the main types of meningitis are indicated in Table 4 [8,[16][17][18].…”

Section: Diagnosis Of Lymphocytic Meningitismentioning

confidence: 99%

“…Within the enterovirus group, there is an important further division into the Picornaviridae family: Echovirus [4,5,7,10,12,16,22,31], the Polioviruses and the Coxsackieviruses of groups A and B 1,2. Enterovirus numbers 70 and 71 show a strong neurotropism, which is associated with meningoencephalitis, polio-like paralytic syndromes, Guillain Barré Syndrome, as along with meningitis.…”

Section: Lymphocytic Meningitis With Infectious Etiology Viral Meningmentioning

confidence: 99%

Laboratorial diagnosis of lymphocytic meningitis

Nogueira

et al. 2007

Braz J Infect Dis

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Meningitis is the main infectious central nervous system (CNS) syndrome. Viruses or bacteria can cause acute meningitis of infectious etiology. The term "Aseptic Meningitis" denotes a clinical syndrome with a predominance of lymphocytes in the cerebrospinal fluid (CSF), with no common bacterial agents identified in the CSF. Viral meningitis is considered the main cause of lymphocyte meningitis. There are other etiologies of an infectious nature. CSF examination is essential to establish the diagnosis and to identify the etiological agent of lymphocytic meningitis. We examined CSF characteristics and the differential diagnosis of the main types of meningitis.

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Informed Consent for Lumbar Puncture

Botkin¹

1989

Arch Pediatr Adolesc Med

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When not to do a lumbar puncture.

Cited by 72 publications

References 13 publications

Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis

Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis

Laboratorial diagnosis of lymphocytic meningitis

Informed Consent for Lumbar Puncture

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