Lumbar puncture position influences intracranial pressure
| Autor: | Morten Andresen, Sarah Hornshøj Pedersen, Lonnie G. Petersen, Marianne Juhler, Alexander Lilja-Cyron |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
musculoskeletal diseases
Supine position Lumbar puncture opening pressure (CSF) Sitting 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid Lumbar Recumbent Position Medicine Hip flexion Neuroradiology Intracranial pressure integumentary system medicine.diagnostic_test business.industry Lumbar puncture musculoskeletal neural and ocular physiology Lumbar puncture position Neck flexion Intracranial pressure (ICP) Surgery Neurology (clinical) Nuclear medicine business 030217 neurology & neurosurgery |
| Zdroj: | Pedersen, S H, Andresen, M, Lilja-Cyron, A, Petersen, L G & Juhler, M 2021, ' Lumbar puncture position influences intracranial pressure ', Acta Neurochirurgica, vol. 163, no. 7, pp. 1997-2004 . https://doi.org/10.1007/s00701-021-04813-3 |
| DOI: | 10.1007/s00701-021-04813-3 |
| Popis: | Background: The standard lumbar puncture position involves maximum flexion of both lumbar and cervical spine. The cerebrospinal fluid opening pressure (CSFop) is measured in a horizontal position. This study investigated if flexion of hip and neck both separately and simultaneously influence intracranial pressure (ICP) to a clinically relevant extent. Methods: Thirty-nine patients, undergoing invasive ICP monitoring as part of diagnostic work-up, were included. The patients underwent either a vertical postural examination (n = 24) or a horizontal postural examination (n = 15) to examine a varying degree of spine flexion. Results: The vertical examination showed that ICP decreased by 15.2 mmHg when straightening the neck in a sitting lumbar puncture position (n = 24, IQR − 20.1 to − 9.7). In the horizontal examination, ICP increased in all but one patient when changing from supine position to lateral recumbent position (n = 15, median increase of 6.9 mmHg, IQR 3.1 to 9.9). Straightening the hips alone decreased ICP with 0.2 mmHg (n = 15, IQR − 0.5 to 2.0), while straightening the neck alone decreased ICP by 4.0 mmHg (n = 15, IQR − 5.9 to − 1.7). However, when straightening the hip and neck simultaneously ICP decreased by 6.4 mmHg (n = 6, IQR − 9.5 to − 4.4). Conclusions: Neck flexion alone, and neck flexion and hip flexion in combination, has significant confounding influence on ICP. This may cause patients to shift from a normal ICP range to a pathological ICP range, which will potentially affect treatment decisions. Consensus on guidelines for body position including neck and hip flexion measuring CSFop may be needed. |
| Databáze: | OpenAIRE |
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