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At least 109 records · Page 6Linked to original sources
PubMed1982

Percutaneous puncture of spinal cysts in the diagnosis and therapy of syringomyelia and cystic tumors.

The experience with percutaneous puncture of intraspinal cystic lesions is reported in four cases: an extradural cyst demonstrated with air, a spinal cord tumor with lipiodol and two cases of syringomyelia with metrizamide. Percutaneous puncture of cystic lesions makes possible an accurate delineation of the lesion and a histological approach through biochemical and cytological analysis of the aspirated cystic fluid, while aspiration of the fluid of cystic tumors decompresses the spinal cord and thus plays a therapeutic role.

Adult↗
PubMed1999

Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature.

Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. Spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.

Acute Disease↗
PubMed1975

Intraspinal epidermoid tumor of the sacral canal presenting with urinary retention.

A case of epidermoid tumor of the sacral area with S3 root irritation resulting in bladder dysfunction is presented and its possible relationship to spinal puncture is discussed. Precautions should be taken to prevent this complication by using a stylet instead of a plain needle. The recognition of this complication should always be in the differential diagnosis of a child with back pain, gait abnormality and bladder dysfunction with a history of spinal puncture.

Back Pain↗
PubMed2000

CSF/serum beta-hCG ratio in patients with brain metastases of gestational trophoblastic tumor.

OBJECTIVE: To assess the accuracy of cerebrospinal fluid (CSF)/serum ratio of beta-subunit of human chorionic gonadotropin (beta-hCG) in detecting brain metastasis of gestational trophoblastic tumor (GTT). STUDY DESIGN: The subjects were ten patients with GTT and brain metastases. Spinal puncture and veni-puncture were performed for measurement of beta-hCG titer in CSF and serum to determine the CSF/serum ratio before starting multiagent chemotherapy and/or brain irradiation. RESULTS: Five patients manifested a CSF/serum beta-hCG ratio > 1/60, and five manifested a ratio < 1/60. CONCLUSION: The CSF/serum beta-hCG ratio is not accurate enough to be routinely considered in the workup, management, and/or surveillance of GTT with brain metastases. Hence, it is perhaps not necessary to perform spinal puncture if the only purpose is to determine the CSF/serum ratio.

Adolescent↗
PubMed1993

[Postdural puncture headache].

PDPH are not the privilege of spinal anaesthesia, as they can occur in various circumstances including epidural anesthesia, surgical wound of the dura, spinal tap and/or myclography. Diagnosis PDPH can be discussed with four etiologies: cortical vein thrombosis, meningitis, intracranial haematomas (intracerebral, subdural) or migraine. PDPH result from the leakage of CSF via the dural hole, responsible of hypotension of CSF in the subarachnoid compartment. Several etiologies and predisposing factors are discussed. The incidence of PDPH varies with age, maximum from 15 to 50 years-old, the decreasing to reach a very low incidence over 65 PDPH seems to occur more frequently in women, especially during pregnancy. The diameter of the spinal needle is the main factor of PDPH. Using small diameters (25 G and less) allows to reduce the percentage of PDPH, as well as using specially designed needles with a "pinpoint bevel" (Sprîtte, Whitacre). When PDPH occur, no specific treatment is required before the fifth day, as they spontaneously resolve in 80% of the patients, without any intervention. After then, epidural blood patch allows 90% success rate. Other therapeutic proposals are discussed. Finally, prevention of PDPH appears to be the keypoint, paying particular attention to the choice of the needle and of the spinal puncture technique.

Anesthesia, Epidural↗
PubMed2002

Epidural hematoma after epidural block: implications for its use in pain management.

BACKGROUND: Spinal epidural hematoma after spinal puncture such as for injection of steroids for pain management may result in a rare complication of a spinal epidural hematoma causing acute myelopathy. Although this complication is well known with epidural anesthesia, where it is usually seen with impaired hemostasis, there are surprisingly few case reports of epidural hematoma after an epidural steroid block. CASE DESCRIPTION: A healthy 34-year-old man with no evidence of coagulopathy and not taking antiplatelet medication suddenly had onset of acute cervical myelopathy from a large cervical epidural hematoma 8 days after a cervical epidural steroid block. Following prompt surgical evacuation of the clot, the patient made a near complete recovery. CONCLUSION: Spinal epidural hematoma after spinal puncture is usually associated with impaired hemostasis. This case illustrates that it may occur in the absence of known risk factors. The delayed onset and the absence of risk factors have implications for the use of this procedure in chronic pain management.

Adult↗
PubMedDate not supplied

[Intraspinal epidermoid cysts and lumbar punctures].

The authors describe a case of intra-spinal epidermoid cyst and recall the scarcity of the symptoms of such tumors and their slow evolution and emphasize the very likely part taken by spinal punctures in the genesis of a number of them.

Child↗
PubMed2005

Recurrent hearing loss after myelography treated with epidural blood patch.

Transient hearing impairment is a known sequel after various procedures that result in loss of cerebrospinal fluid, such as lumbar puncture, spinal anesthesia and myelography. But persistent or recurrent hearing loss after dural puncture is a rare entity. We present a case with recurrent low-frequency sensorineural hearing loss after myelography. The patient was treated successfully by means of an epidural blood patch, although the conservative treatment was ineffective.

Blood Patch, Epidural↗
PubMed2000

[Multivariate study of risk factors for arterial hypotension in pregnant patients at term undergoing Caesarean section under subarachnoid anesthesia].

OBJECTIVES: The most common and potentially dangerous complication of spinal anesthesia for cesarean section is arterial hypotension. The aim of this study was to analyze maternal and gestational factors that might affect risk of arterial hypotension in full-term parturients undergoing cesarean section. MATERIAL AND METHOD: We enrolled full-term parturients scheduled for elective cesarean section under spinal anesthesia. Spinal puncture was performed at L2-L3 using an atraumatic Sprotte-type needle. We administered 12.5 mg of hyperbaric 0.5% bupivacaine and 12.5 micrograms of fentanyl. Arterial hypotension was defined as a decrease in systolic pressure of at least 20% or a decrease to a pressure below 100 mmHg. Multivariate analysis was performed to identify factors related to the presentation of hypotension appearing in the interval between spinal puncture and birth. RESULTS: The incidence of arterial hypotension was 33.3%. Statistical analysis revealed that integrity of the amniotic sac, parity and elective cesarean were significantly associated with a higher incidence of arterial hypotension (p < 0.03). CONCLUSIONS: Identifying risk for multiparous parturients with intact amniotic sacs scheduled for elective cesarean can be worthwhile if greater preventive measures are taken in such patients to reduce the incidence and intensity of arterial hypotension.

Abdominal Pain↗
PubMedDate not supplied

Preoperative diclofenac is a useful adjunct to spinal anesthesia for day-case varicose vein repair.

PURPOSE: To examine if preoperative diclofenac 50 mg or diazepam 10 mg po are useful adjuncts to spinal anesthesia for day-case varicose vein repair. METHODS: Two hundred ASA physical status I-II outpatients, age 18-60 yr, were randomized to receive either diclofenac 50 mg po or diazepam 10 mg po one hour before operation in a double-blind fashion (100 patients in both groups). If the patient was distressed or feared the spinal puncture and requested sedation, a bolus dose of alfentanil 0.5 mg was given i.v. as a rescue medication. On request, patients received diclofenac 50 mg po and, when needed, oxycodone 0.1 mg x kg(-1) im for postoperative pain relief. They were discharged with a supply of diclofenac 50 mg tablets and were asked to record postoperative pain using a visual analogue scale (VAS) and quantity of tablets taken. RESULTS: The VAS scores (+/- SD) eight hours after surgery, the next morning, and in the morning and at the end of the first and second postoperative days were 23 +/- 21, 12 +/- 17, 11 +/- 15, 8 +/- 15 and 8 +/- 15 in the diclofenac group, and 24 +/- 23, 12 +/- 20, 10 +/- 17, 8 +/- 16 and 7 +/- 14 in the diazepam group, respectively (NS). In the diclofenac and diazepam groups, 31% and 67% of the patients required postoperative diclofenac during the first eight postoperative hours (P <0.05). Diazepam premedication did not alter the number of patients who required alfentanil before spinal puncture. CONCLUSION: Diclofenac premedication reduced the analgesic requirements during the first eight hours after varicose vein repair.

Adolescent↗
PubMed1992

Incidence and risk factors for side effects of spinal anesthesia.

We prospectively studied 952 patients to identify the incidence of hypotension (systolic blood pressure less than 90 mmHg), bradycardia (heart rate less than 50 beats/min), nausea, vomiting, and dysrhythmia during spinal anesthesia. Historical, clinical, and physiologic data were correlated with the incidence of these side effects by univariate and multivariate analysis. Hypotension developed in 314 patients (33%), bradycardia in 125 (13%), nausea in 175 (18%), vomiting in 65 (7%), and dysrhythmia in 20 (2%). Variables conferring increased odds of developing hypotension include peak block height greater than or equal to T5 (odds ratio 3.8, P less than 0.001), age greater than or equal to 40 yr (2.5, P less than 0.001), baseline systolic blood pressure less than 120 mmHg (2.4, P less than 0.001), combination of spinal and general anesthesia (1.9, P = 0.01), spinal puncture at or above the L2-L3 interspace (1.8, P less than 0.001), and addition of phenylephrine to the local anesthetic (1.6, P = 0.02). Variables conferring increased odds of developing bradycardia include a baseline heart rate less than 60 beats/min (odds ratio 4.9, P less than 0.001), ASA physical status classification of 1 versus 3 or 4 (3.5, P less than 0.001), current therapy with beta-adrenergic blocking drugs (2.9, P less than 0.001), and peak block height greater than or equal to T5 (1.7, P = 0.02). Variables conferring increased odds of developing nausea or vomiting include addition of phenylephrine or epinephrine to the local anesthetic (3.0-6.3, P less than or equal to 0.003), peak block height greater than or equal to T5 (odds ratio 3.9, P less than 0.001), use of procaine (2.6-4.4, P less than or equal to 0.003), baseline heart rate greater than or equal to 60 beats/min (2.3, P = 0.03), history of carsickness (2.0, P = 0.01), and development of hypotension during spinal anesthesia (1.7, P = 0.009). Our results indicate that the incidence of side effects during spinal anesthesia may be reduced by 1) minimizing peak block height; 2) using plain solutions of local anesthetics; 3) performing the spinal puncture at or below the L3-L4 interspace; and 4) avoiding the use of procaine in the subarachnoid space.

Adult↗
PubMed2000

Repeated lumbar or ventricular punctures for preventing disability or shunt dependence in newborn infants with intraventricular hemorrhage.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether repeated CSF tapping, by lumbar puncture or ventricular tap, reduced the risk of permanent shunt dependence, neurodevelopmental disability or death in neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus (PHH). This form of treatment was based on the hypothesis that repeated tapping removed protein and blood from the CSF, thus clearing obstruction from the channels of CSF absorption. SEARCH STRATEGY: Pediatric, Neurosurgical and General Medical Journals were handsearched from 1976, as well as the Medline database. Personal contacts were used. SELECTION CRITERIA: Four controlled trials ( with five published papers) were identified, three being randomised and the fourth using alternative allocation. Two trials evaluated repeated lumbar punctures in neonates with intraventricular hemorrhage (IVH) and two trials evaluated repeated CSF tapping infants with IVH followed by progressive ventricular dilatation. DATA COLLECTION AND ANALYSIS: In addition to details of the patient selection and patient allocation, the interventions were extracted. The end-points examined were: ventriculoperitoneal shunt, death, disability, multiple disability and death or disability. MAIN RESULTS: The studies were sufficiently similar in the question they were asking and the interventions were sufficiently in common that they could be combined when assessing the effect of the intervention. When repeated CSF tapping was compared to conservative treatment, the relative risks for shunt placement, death, disability and multiple disability were very close to 1.0 with no statistically significant effect. There is also evidence that this form of treatment increased the risk of CSF infection. REVIEWER'S CONCLUSIONS: Early repeated CSF tapping cannot be recommended for neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus.

Cerebral Hemorrhage↗