[Headache after lumbar puncture in spinal anesthesia. Analysis of risk factors].
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[Diagnostic value of spinal puncture-biopsy in non-infectious spinal diseases. Apropos of 41 cases].
To evaluate the diagnostic value of percutaneous vertebral biopsy in noninfectious diseases of the spine, we retrospectively studied 41 cases seen between 1985 and 1992. The level of the lesion was lumbar in 29 cases, thoracic in 11, and cervical in one. There were 19 crush fractures, 11 lytic lesions, six sclerotic lesions, and three mixed lesions. The biopsy was done because of an abnormal magnetic resonance imaging signal in one patient and because of epiduritis in another. The thoracic and lumbar biopsies were done under x-ray guidance using the technique developed by Laredo and Bard. Computed tomography guidance was used for the cervical biopsy. There were no adverse events. The final histological diagnosis was metastatic disease in 17 cases (41.5%), myeloma or plasmacytoma in six cases (14.7%), primary vertebral neoplasia in two cases (4.8%), lymphoma in one case (2.4%), osteoporosis in nine cases (22%), Paget's disease in three cases (7.4%), amyloidosis in one case (2.4%), aseptic osteitis in one case (2.4%), and vertebral necrosis in one case (2.4%). A second biopsy procedure was done in three patients (surgically in two cases and percutaneously in one) because of discrepancies between histological findings and other data. The final diagnosis was metastatic disease in all three patients. Overall, the diagnostic yield of percutaneous vertebral biopsy was 92.6% and varied little with initial roentgenographic or computed tomographic findings. However, yield was only 56% for the diagnosis of tumorous lesions, with variations according to roentgenographic and computed tomographic changes, 90.1% for osteolytic lesions, 66.6% for mixed lesions, 47.4% for crush fractures, and 16.6% for sclerotic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Long-term follow-up of patients who received 10,098 spinal anesthetics. IV. Neurological disease incident to traumatic lumbar puncture during spinal anesthesia.
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Anesthesia↗
Comparison of ketmine with the combination of ketamine and xylazine for effective anesthesia in the rhesus monkey (Macaca mulatta).
The addition of xylazine to ketamine hydrochloride was found to enhance analgesia, anesthesia, and muscle relaxation in rhesus monkeys. At 0.10 ml/kg body weight, this combination provided adequate anesthesia for such procedures as cisternal puncture, lumbar spinal puncture, insertion of urinary catheters, finger amputations, and tattooing. The combination of ketamine and xylazine did depress the heart rate, respiration rate, and body temperature more than the administration of ketamine alone. The period of anesthesia also was prolonged, but the monkeys regained consciousness more rapidly at the end of the anesthetic period.
Anesthesia↗
Danger of lumbar puncture in spinal cord compression.
Rapid deterioration in the symptoms and signs of spinal cord compression following lumbar puncture is an unusual complication which must be thought of before undertaking this procedure as part of myelography.
Adult↗
[Anesthesia for cesarean section in a patient with Lobstein's syndrome].
We report on a 21-year-old woman with a severe form of Lobstein's syndrome, who underwent a Cesarean section. The following issues are discussed: the risk of sustaining fractures during positioning, fractures by automatic blood pressure measurement, an almost always existing latex allergy, a susceptibility for malignant hyperthermia, potential cardiac defect, difficult endotracheal intubation, lowering of the conus medullaris to an area usually used for spinal puncture, severe spinal deformities resulting in difficult puncture, hemorrhagic diathesis, and unpredictability of the expansion of local anesthetics in the vertebral canal. In this case the procedure could be carried out in spinal anesthesia without encountering major problems.
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Management of postdural puncture headache with epidural blood patch in children.
BACKGROUND: Until the last decade, it was believed that postdural puncture headache (PDPH) was an uncommon complaint in children, but recent studies indicate that young children may develop PDPH after spinal puncture. When the symptoms are severe and are not relieved within a few days with analgesics, forced hydration and bed rest, then epidural blood patch (EBP) might be performed. METHODS: In this retrospective survey, we analysed EBP performed in Kuopio University Hospital between the years 1995 and 2000. RESULTS: During the 6-year period, seven EBP were performed in children aged 12 years or younger. Four out of the seven children had undergone a diagnostic spinal puncture, two had spinal anaesthesia and one child had spinal puncture for treatment of postoperative hygroma. Five children had a typical PDPH, one child had a cerebrospinal fluid fistula headache and one child had a headache similar to his migraine. EBP was performed 2-19 days after spinal puncture with 0.3 ml.kg-1 (mean) of autologous blood injected into the epidural space. CONCLUSIONS: EBP gave some relief of symptoms in all children. No complications related to EBP were noticed.
Blood Patch, Epidural↗
Intracranial subdural hematoma after puncture of spinal meningeal cysts.
A patient is reported with an intracranial subdural hematoma after puncture of spinal meningeal cysts. In this case, spinal meningeal cysts were diagnosed by myelography. No intracranial subdural hematoma was detected immediately after myelography. Deterioration in the patient's level of consciousness occurred after puncture of the cysts. The authors speculated that the cerebrospinal fluid pressure dropped rapidly when the spinal meningeal cysts were punctured. This displaced the cerebral bridging veins downward, tearing them and resulting in an intracranial subdural hematoma.
Central Nervous System Cysts↗
Positive lumbar extradural space pressure.
Specially selected soft Macintosh balloon indicators were attached to needles during five extradural and five spinal punctures. When the needle point entered the extradural space, the mean balloon pressure decreased suddenly from 24.9 (range 14-37) to 12.3 (10-16) mm Hg in the five extradural punctures and from 22.3 (17-28) to 13.7 (10-17) mm Hg in the five spinal punctures. In the five spinal punctures, the balloon pressure did not alter when the needle was advanced from the extradural to the subarachnoid space. Contrary to expectation, none of the balloons deflated when the needle point entered the extradural or subarachnoid spaces. The balloon pressure varied rhythmically in synchrony with respiration and cardiac pulsations. The final balloon pressure, extradural space pressure and subarachnoid pressure were equal. The results suggest that the extradural pressure is positive and of the same magnitude as the prevailing lumbar cerebrospinal fluid pressure. Jugular venous compression, ventilation with carbon dioxide and positive end-expiratory pressure (PEEP) produce a rapid increase in cerebrospinal fluid (CSF) pressure. These stimuli also produced a measurable increase in the lumbar extradural pressure. Jugular venous compression increased the mean lumbar extradural pressure by 6.8 (3-10) mm Hg and ventilation with carbon dioxide increased it by 10 (5-12.5) mm Hg. PEEP values of 5, 10, 15 and 20 cm H2O produced an immediate increase in extradural pressure of 1-2 mm Hg for every 5 cm H2O of PEEP. The lumbar extradural pressure increased rapidly with stimuli known to increase CSF pressure. Changes in spinal CSF pressure may be detected by measuring extradural pressure.
Adult↗
Immediate mini-myelography in acute cervical cord injuries.
The use of contrast myelography in the evaluation of acute cervical spinal cord trauma is controversial. The purpose of employing such a technique is to demonstrate any persistent extradural cord compression after the spine is realigned by skeletal traction. The surgical correction of such compression may result in enhanced neurological recovery. The "mini-myelogram" is accomplished by performing a lateral C1/C2 spinal puncture and injecting a low volume of Pantopaque into the subarachnoid space. Demonstration of significant extradural compression results in emergency surgery for appropriate decompression. A small percentage of patients may enjoy enhanced recovery due to the decompression. A description of the technique and results of 90 patients undergoing mini-myelography are presented.
Adult↗
Epidural blood patch for management of postdural puncture headache in adolescents.
BACKGROUND: In some patients spinal puncture (SP) is followed by postdural puncture headache (PDPH). When the symptoms of PDPH are severe and are not relieved within a few days an epidural blood patch (EBP) might be performed. The aim of this survey was to review requests for EBPs and to evaluate the effectiveness of EBP in patients aged 13-18 years during a 6.5 year period ending in June 2001. METHODS: The Information System Patient Measures Database was interrogated to identify patients who were referred for EBP. After identification, the patients' medical records were reviewed in detail for the characteristics of PDPH and other symptoms, and for the effectiveness of the EBP. RESULTS: Forty-two EBPs were performed after 40 SPs on 37 patients (24 girls, 13 boys). Epidural blood patches were performed twice in five patients. The reasons for repeating the procedure were repeat SP with new PDPH in three patients and an unsatisfactory effect in two patients. Twenty-eight of the 40 spinal punctures (70%) had been performed for diagnostic use and 10 (25%) for spinal anesthesia. Two patients (5%) developed PDPH after inadvertent dural puncture with an epidural needle. In 37 cases the criteria for PDPH were fulfilled, and one patient had a cerebrospinal fluid fistula headache. Two-thirds of the girls had associated symptoms of headache compared with one-third of the boys. Epidural blood patch was performed 1-22 days after SP with 0.2 ml/kg (mean) of autologous blood injected into the epidural space. The success rate of the first injection was 37 out of 40 EBP (93%), and the second injection was effective in both patients with recurred PDPH. CONCLUSION: Epidural blood patch seems to be an effective and safe procedure in adolescents for treating severe and persistent PDPH.
Adolescent↗
Venous intravasation of pantopaque during myelography. Report of two cases and a review of the literature.
Pantopaque venous intravasation, an uncommon complication of myelogram, has been reported since 1945. Traumatic spinal puncture has been known to be associated with Pantopaque venous intravasation, but its close relationship with the level of spinal puncture at the L5-S1 intervertebral disc space has not been emphasized. Spinal puncture at that level should be discouraged in order to prevent Pantopaque venous intravasation and pulmonary embolism during myelography.
Adult↗
Epidural injection of lidocaine reduces the response to dural puncture accompanying spinal needle insertion when performing combined spinal-epidural anesthesia.
During placement of needles for combined spinal-epidural anesthesia (CSEA), patients may experience pain, pressure, paresthesia, or discomfort during skin and deeper injection of local anesthetic, needle impingement on periosteum, dural puncture by the spinal needle, and insertion of the epidural catheter. We investigated the incidence of perception of and spontaneous verbal and motor responses to insertion of a spinal needle through the dura mater and pia mater and the effect of injecting lidocaine into the epidural space through the epidural needle before inserting the spinal needle through the meninges. Forty-three patients presenting for elective cesarean delivery under CSEA were studied. After localization of the epidural space using loss of resistance to air using a 17-gauge Tuohy needle, either 3 mL preservative free normal saline or 3 mL lidocaine 2% plus epinephrine 1:200,000 was injected through the Tuohy needle. "Needle through needle" dural puncture was performed 1 min later using a 27-gauge Whitacre pencil-point needle. At the moment of dural puncture, 2 (9%) parturients given lidocaine and 17 (81%) parturients given saline (P < 0.005) responded to dural puncture by spontaneously moving (33%), spontaneously vocalizing (62%), or, in response to direct questioning, by acknowledging (76%) having perceived sensation during thecal penetration. This study reveals that dural puncture by a Whitacre 27-gauge pencil-point needle inserted through a Tuohy epidural needle sited using loss of resistance to air causes involuntary movement, spontaneous vocalization, or is perceived by the majority of patients presenting for cesarean delivery under CSEA and that lidocaine injected into the epidural space before dural puncture largely eliminates these responses and sensations.
Adult↗
[Importance of spinal cord puncture in craniocerebral injury].
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Adult↗
[The effects of midazolam on the memory of pain].
The purpose of this study was to evaluate the effects of low dose midazolam (MZ) on memories of spinal puncture. The low doses of MZ were administered to 70 patients (ASA 1-2), of whom 37 patients were premedicated with atropine sulfate 0.5 mg and pethidine hydrochloride i.m. (group P), and 33 patients received no premedication (group N). Double blind randomized trials were conducted with the doses of MZ (0, 0.03, 0.06 mg.kg-1), and MZ was administered i.v. to the patients just prior to spinal puncture. Subjective evaluation of pain was performed with pain score (PS) on postoperative phase, and objective evaluation of pain was performed with the reaction of spinal puncture. Short term memory was impaired mainly after administration of MZ. However, subjective memory of pain almost disappeared, but objective evaluation was not so good. We conclude that MZ induces impairment to recall of pain. However, it might maintain the response to the pain.
Adjuvants, Anesthesia↗
Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms.
Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.
Adult↗
Intraspinal epidermoid tumors caused by lumbar puncture.
It is well known that congenital intraspinal epidermoid tumors, while rare, do occur. That they may also be related to spinal puncture is less well understood. In the present article, four such cases are described, including one in which an earlier myelogram performed because of lumbar disk disease showed that no tumor was present prior to the spinal puncture. The pertinent literature is reviewed, and the probable mechanism of formation of such tumors and the means for avoiding it are discussed.
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