DOCSLIB.ORG

Intracranial Pressure Monitoring

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Intracranial Pressure Monitoring Arch Dis Child: first published as 10.1136/adc.59.5.486 on 1 May 1984. Downloaded from Archives of Disease in Childhood, 1984, 59, 486-488 Personal practice Intracranial pressure monitoring R A MINNS Department of Child Life and Health, University of Edinburgh Increasing awareness of the part played by raised puncture and with no undue abdominal compres- intracranial pressure in brain damage together with sion, flexion or extension of the neck. Where there clinical signs which are often unreliable and the is free communication between the spinal and static nature of ultrasound or computed tomography cranial compartments the measured pressure re- for what is essentially a dynamic problem have flects the intracranial pressure. A paper recording of meant that there is now widespread acceptance of a few minutes duration is made before cerebrospinal intracranial pressure monitoring in children. The fluid collection, with the transducer attached to the reasons for monitoring are to detect raised pressure, lumbar puncture needle by a three way connection. to quantitate this, and to determine the effectiveness The presence of a cardiorespiratory artefact verifies of treatment. the space and because there is no displacement of cerebrospinal fluid this method is theoretically safer. Techniques and indications The mean pressure is independent of the internal bore of the lumbar puncture needle, although This review article mentions only a few of the many oscillations wilJ be damped with fine bore needles. devices and techniques presently available for intra- This simple adaptation improves appreciably the cranial pressure monitoring. For routine clinical use routine practice of estimating cerebrospinal fluid the keynote should be simplicity-in the type of# pressure at the time of lumbar puncture and equipment used, method of calibration, routine for equipment for this should be available in most http://adc.bmj.com/ checking time and temperature drift, sterilisation, treatment rooms and accident departments. and in a standard zero reference value. Basic Measurement can be performed after brief instruc- equipment, which can be used in most circumstances tion on how to calibrate and sterilise the equipment; and is inexpensive compared with modern hospital most children find it no more uncomfortable than equipment, consists of a small Luer-locking solid the lumbar puncture procedure has always been; state transducer (for example, Gaeltec or Statham), and it can be carried out in any paediatric age group. a pre-amplifier, and a physiological pen recorder. More sophisticated display, storage, and data pro- (2) When the ventricles are enlarged. The most on September 25, 2021 by guest. Protected copyright. cessing with microprocessors or computers may, accurate intracranial pressure recordings are however, be desired. There are three principal obtained from the ventricles, either directly from opportunities for measuring intracranial pressure. ventricular cannulation (burr or twist drill hole) or via a ventriculostomy reservoir connected to an (1) At the time of lumbar puncture. Traditional external transducer. This is the method of choice in practice has been to measure cerebrospinal fluid the older child where the ventricles are easily pressure at lumbar puncture by open ended man- located. As little cerebrospinal fluid as possible ometry but this method is fraught with inaccuracies should be spilt and all joints must be watertight. It in routine practice. The mere fact that cerebrospinal allows easy recalibration, a means of controlling fluid is displaced from a closed system to fill a pressure (by drainage against a pressure of 10 column is fundamentally error producing; 'eyeball- mmHg) and has the additional advantage of en- ing' a fluctuating meniscus and the need for several abling pressure volume responses (PVI in mmHg/ pairs of hands have negated much of its usefulness. ml) to be carried out, thus identifying patients at risk Measurement can now be accomplished simply of pressure decompensation.' without displacement of cerebrospinal fluid with the For the older child with active hydrocephalus, patient in the lateral recumbent postion for lumbar management is dramatically altered by placing a 486 Arch Dis Child: first published as 10.1136/adc.59.5.486 on 1 May 1984. Downloaded from Intracranial pressure monitoring 487 separately sited reservoir (usually in the right frontal cranial bones after a threader has been used on the horn) at the same time as definitive cerebrospinal inner aspect of the drill hole. Again this equipment fluid shunt insertion, thus providing both access and is inexpensive and the apparatus may be calibrated drainage. When there is subsequent block or infec- externally. tion of the shunt simple tapping of the reservoir and The use of screws in the epidural space, which direct intracranial pressure recording will often avoids opening the dura and theoretically lessens the delineate the problem. Equivocal pressure results risk of seizures, haematoma, or infection has not may necessitate a provocation record through sev- proved reliable because of signal damping. Subdural eral rapid eye movement sleep phases when intra- placement also records disparate pressures (com- cranial pressure increases as a result of enhanced pared with ventricular pressure) at values greater cerebral blood flow. than 20 mmHg. Intracranial catheter tip pressure Ventricular pressure monitoring is also helpful in transducers for epidural use and implanted epidural children with intermittently active hydrocephalus transducers probably only approximate cerebro- and long standing pressure symptoms and those with spinal fluid pressure and are inferior to the screw in space occupation from tumour, clot, cyst, or ab- my experience. scess. The use of this method in tuberculous menin- There are additional problems in infancy and in gitis, ventriculitis, and other meningitides has also the newborn-swollen brain syndromes consequent allowed better control of intracranial pressure while on anoxic ischaemic injury, central nervous system the infection is being treated. infections etc. Neonatal methods which have been A telemetric pressure sensor for hydrocephalus used include measurements from most of the surface and ventricular shunt systems2 combines a telemet- spaces such as the subarachnoid or subdural5 where ric device attached to either the proximal limb of a a wide bore medicut is introduced via the anterior cerebrospinal fluid shunt or a reservoir. This allows fontanelle using a conventional subdural puncture in vivo confirmation of zero point and pressure procedure and leaving a teflon catheter in situ. calibrations by means of pressure balanced tele- (These are attractive because they are easy to metry. This may prove of value in the outpatient insert). It is important, however, to ensure that assessment of hydrocephalic states in the future and movement of the catheter does not cause air liquid is currently under evaluation in Edinburgh. interfaces thus falsifying the recorded intracranial In neonates with ventriculomegaly short opportu- pressure. These methods require further validation nistic records may be obtained at the time of by comparison with ventricular pressures. A re- percutaneous ventricular puncture but prolonged cently designed, plastic miniaturised screw is cur- http://adc.bmj.com/ recordings require that a finer, non-compliant cath- rently on trial for this group of children. Its smaller eter be left in situ. If the ventricles are not easily size and light weight make it more desirable for the located this way no more than two attempts should thin cranial bones of infancy. be allowed before alternative techniques are sought. Many forms of fontonometry have been tried over Insertion of a miniaturised ventriculostomy reservoir the past 10 years such as the Ladd device, stetho- of the type recently designed (Steers J; personal scope 'pick ups', tambours, modified Schiotz tono- communication) may be a useful alternative to meter, aplanation transducers, pressure activated repeated puncture or hardware of adult dimensions. fibreoptic sensors, oscillographic technique, saggital on September 25, 2021 by guest. Protected copyright. sinus pressure or bloodflow, and impedence, and (3) At the brain surface. In older children with while varying degrees of success have been achieved conditions of brain swelling in coma and decerebrate fundamental problems still exist with coplanimetry, states such as Reye's syndrome, anoxic-ischaemic the external pressure applied, tension in the fon- encephalopathy, and head injury a fluid filled metal tanelle etc, making these methods suitable for screw is mounted in a twist drill hole and placed in research but of limited value in routine clinical the subarachnoid space.3 This avoids brain punc- practice. ture, is secure on the skull, and is independent of shifts or small ventricular size. Several types of Recordings screw have been used such as the single lumen screw and the Leeds screw but my preference is for the The zero reference value is usually taken as the Newell modification of the Leeds screw which is foramen of Munro (mid-cranium) with the patient stainless steel, simple in design, without movable supine. The hydraulic system of blood brain and parts, easily autoclaved, and has a luer connection cerebrospinal fluid is responsible for the normal for attachment to the transducer. It is imperative intracranial pressure. For older children and adults that a good bolt-space connection is maintained
Load more

Recommended publications
  • Lumbar Puncture (LP)
    Lumbar puncture (LP) What is a lumbar puncture (LP)? Who will perform this test? An LP is a common and routine procedure, also A doctor trained in performing this procedure known as a spinal tap, where a very small will do the LP. A trained children’s nurse will hold needle is inserted through the base of the spine your infant in the appropriate position (which to collect a sample of the fluid surrounding the is lying on their side curled up in a tight ball). brain and spinal cord. This fluid is called Another team member may also be present to cerebrospinal fluid (CSF). help. Why do we need to do this? Can you be present during the LP? LP is the only way to confirm a case of Yes, you can tell the team that you would like to meningitis (swelling of the lining of the brain be present. However, many parents find it caused by an infection in the CSF). distressing to see any procedures being done on their baby and would rather not be present. This National guidelines strongly recommended that is perfectly understandable. Please let the team an LP is done alongside other routine know and they will usually agree to whatever investigations, such as blood and urine tests, works best for you but be aware that it is best to look for signs of infection if meningitis is to be quiet so the doctor can concentrate on the suspected. This is a routine and very important procedure. investigation. Is it a painful procedure? Getting a sample of CSF will help Drs to find out An LP is an uncomfortable procedure similar to if your child has meningitis and if what is a blood test or drip being inserted.
    [Show full text]
  • Post-Lumbar Puncture Headache—Does Hydration Before Puncture Prevent Headache and Affect Cerebral Blood Flow?
    Journal of Clinical Medicine Article Post-Lumbar Puncture Headache—Does Hydration before Puncture Prevent Headache and Affect Cerebral Blood Flow? Magdalena Nowaczewska 1,* , Beata Kukulska-Pawluczuk 2, Henryk Ka´zmierczak 3 and Katarzyna Pawlak-Osi ´nska 1 1 Department of Pathophysiology of Hearing and Balance, Ludwig Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland; [email protected] 2 Department of Neurology, Ludwig Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland; [email protected] 3 Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-52-585-4716 Received: 8 September 2019; Accepted: 15 October 2019; Published: 17 October 2019 Abstract: Headache is a common complication after diagnostic lumbar puncture (DLP). We aimed to check whether hydration before puncture influences the incidence of post-lumbar puncture headache (PLPH) and affects cerebral blood flow. Ninety-nine patients enrolled for puncture were assigned to a group with (n = 40) or without hydration (n = 59). In the hydration group, 1000 mL 0.9% NaCl was infused and a minimum of 1500 mL oral fluids was recommended within the 24 h before puncture. A Transcranial Doppler (TCD) was performed before and after DLP. Mean velocity (Vm) and pulsatility index (PI) were measured in the middle cerebral arteries (MCAs). PLPH occurred in 28 patients (28.2%): six (15.4%) from the hydrated and 22 (37.3%) from the non-hydrated group (p < 0.023).
    [Show full text]
  • The Clinical Effect of Lumbar Puncture in Normal Pressure Hydrocephalus
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.45.1.64 on 1 January 1982. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry 1982;45:64-69 The clinical effect of lumbar puncture in normal pressure hydrocephalus C WIKKELS0, H ANDERSSON, C BLOMSTRAND, G LINDQVIST From the Department of Neurology and Neurosurgery, Sahlgren Hospital, University of Goteborg, Sweden SUMMARY Owing to all the difficulties involved in selecting patients with normal pressure hydro- cephalus for shunt-operation, a cerebrospinal fluid-tap-test (CSF-TT) is introduced. Psychometric and motor capacities of the patients are measured before and after lumbar puncture and removal of 40-50 ml CSF. Patients fulfilling criteria for normal pressure hydrocephalus were compared to patients with dementia and atrophy shown by computed tomography. Normal pressure hydro- cephaluspatients showed temporary improvement after lumbar puncture. The extent ofthe temporary improvement appeared to be well correlated with the improvement after shunt operation. Accord- ingly, the CSF-TT seems to be of value when selecting those patients who will probably benefit from a shunt operation. The syndrome of normal pressure hydrocephalus is pressure by lumbar puncture caused both subjective Protected by copyright. characterised by gait disturbance, progressive mental and objective temporary improvement in some deterioration and urinary incontinence.' Particularly patients with normal pressure hydrocephalus.10 16 17 noteworthy is the complex gait disturbance with Such patients also improved after CSF-shunting. spastic-ataxia, extrapyramidal components, and However, no details have been given about the commonly dyspraxia of gait.2 In addition, there is in amount of CSF which was drained or to what degree typical cases mental "slowing up" with lack of the CSF pressure was lowered.
    [Show full text]
  • Ventriculoperitoneal Shunts in the Emergency Department: a Review
    Open Access Review Article DOI: 10.7759/cureus.6857 Ventriculoperitoneal Shunts in the Emergency Department: A Review Michael Ferras 1 , Nicholas McCauley 1 , Trilok Stead 2 , Latha Ganti 3, 4, 5 , Bobby Desai 6 1. Emergency Medicine, Ocala Regional Medical Center, University of Central Florida, Ocala, USA 2. Emergency Medicine, Trinity Preparatory School, Winter Park, USA 3. Emergency Medicine, Envision Physician Services, Orlando, USA 4. Emergency Medicine, University of Central Florida College of Medicine/Hospital Corporation of America Graduate Medical Education Consortium of Greater Orlando, Orlando, USA 5. Emergency Medicine, Polk County Fire Rescue, Bartow, USA 6. Emergency Medicine, Ocala Regional Medical Center, University of Central Florida College of Medicine, Ocala, USA Corresponding author: Latha Ganti, [email protected] Abstract In this paper, we review the indications, complications, and pitfalls associated with ventriculoperitoneal (VP) shunts. As most VP shunt problems initially present to the emergency department, it is important for emergency physicians to be well-versed in managing them. In the article, the possible reasons for shunt failure are explored and summarized using an infographic. We also examine potential clinical presentations of VP shunt failure. Categories: Emergency Medicine, Neurosurgery Keywords: ventriculoperitoneal shunts Introduction And Background Emergency department physicians usually see a large number of patients with medical maladies managed by the aid of instrumentation or hardware such as a ventriculoperitoneal (VP) shunt. While patients have shunts placed for multiple reasons, it is important for emergency service providers to know how to evaluate, troubleshoot, and treat those with VP shunt complications. An estimated 30,000 VP shunt procedures are performed yearly in the United States [1].
    [Show full text]
  • Role of Lumbar Puncture in Traumatic Brain Injury
    308 Indian Journal of Public Health Research & Development, April-June 2021, Vol. 12, No. 2 Role of Lumbar Puncture In Traumatic Brain Injury Ranjeet Kumar Jha1, Rachna Gupta2 1Assistant Professor, Department of Neurosurgery, 2Professor, Department of Surgery, Shyam Shah Medical College, Rewa Abstract Background: Cerebrospinal fluid (CSF) drainage via ventricular puncture is an established therapy of elevated intracranial pressure (ICP). In contrast, lumbar CSF removal is believed to be contraindicated with intracranial hypertension. Method: We investigated the safety and efficacy of lumbar CSF drainage to decrease refractory elevated ICP in a small cohort of patients with traumatic brain injury (TBI). A score (0–8 points) was used to assess computed tomography (CT) images for signs of herniation and for patency of the basal cisterns. All patients received lumbar CSF drainage either as a continuous drainage or as a single lumbar puncture (LP). Type and method of CSF drainage, mean ICP 24 h prior and after CSF removal, and adverse events were documented. Outcome was assessed after 3 months (with dichotomized Glasgow outcome scale). Results: Eight patients were evaluated retrospectively. n = 5 suffered a moderate, n = 2 a severe TBI (one Glasgow coma score not documented). The CT score was ≥5 in all patients prior to LP and decreased after puncture without clinical consequences in two patients. The amount of CSF removal did not correlate with score changes (P = 0.45). CSF drainage led to a significant reduction of mean ICP (from 22.3 to 13.9 mmHg, P = 0.002). Continuous drainage was more effective than a single LP. Three of eight patients reached a favorable outcome.
    [Show full text]
  • Neuroradiology Section Image Guided Spine Procedures Guidelines for Clinicians
    Neuroradiology Section Image Guided Spine Procedures Guidelines for Clinicians Critical Laboratory Values for Lumbar Puncture/Myelography Lab Test PLT INR PTT Lab Value >25,000 <1.5 Within normal range When to check labs? Inpatients/ER: Check INR, PLT, PTT within 1 week of LP (or within 24 hours if on chemo with low plts) Outpatients: If patient has a history of cancer, bleeding disorder or liver disease, follow guidelines for inpatients/ER patients If patient is on Coumadin, see below for specific recommendations. Otherwise, outpatients do not need labs. Pregnancy: Women of child bearing age should confirm negative pregnancy status Medication Guidelines for LP/Myelograms Medication Recommendation Comments NSAIDS: Ibuprofen, Diclofenac, Do not stop Ketoprofen, Ketorolac, Indomethicin, Naproxen, Sulindac, Diflunisal, Celecoxib ASA Do not stop Aggrenox/persantine (ASA and Stop 1-2 days Restart after 24 hours Dipyridamole), Pletal (Cilostazol) Plavix (Clopidogrel), Prasugrel Stop 5 days Restart 24 – 48 hours (Effient), Ticagrelor (Brilinta) Warfarin Stop 5 days INR <1.5 day of procedure Heparin IV Stop 4 hours Restart 2 – 4 hours Heparin SQ Stop 6-8 hours Restart 6 – 8 hours Enoxaparin (Lovenox), Stop 12 hours Restart 12 – 24 hours Dalteparin (Fragmin), Tinzaparin Fondaparinux (Arixtra) Stop 72 hours Restart 24 – 48 hours Dabigatran (Pradaxa) Stop 1 – 2 days if Cr Cl > Restart 24 hours 50ml/min Stop 3 – 5 days if Cr Cl < 50ml/min Bivalrudin (Angiomax) Stop 2 – 3 days if GFR >50 Stop 3 – 5 days if GFR < 50 Lepirudin (Refludan), Argatroban 4 hours (Novastan) Desrudin Stop 12 hours if Cr Cl >30 ml/min Stop 24 hours if Cr Cl < 30 ml/min Rivaroxaban (Xarelto), Apixaban Stop 24 hours if Cr Cl > 30ml/min Restart 24 hours (Eliquis) Stop 48 hours if Cr Cl < 30ml/min Edoxaban (Savasya, Lixiana) Stop 48 hours if Cr Cl >50 ml/min Restart 24 hours if Cr Cl >50 ml/min Stop 72 hours if Cr Cl <50 ml/min Restart 24 hours if Cr Cl <50 ml/min Abciximab (Reopro) Stop 24 hours Aggrastat (Tirofiban), Eptifibatide Stop 4 hours (Intergrelin) Spinal Procedures.
    [Show full text]
  • Ventriculoperitoneal Shunt Occlusion and Cranioplasty. a Case Report
    Ventriculoperitoneal shunt occlusion and cranioplasty. A case report Lívio Pereira de Macêdo, Arlindo Ugulino Netto, Juan Pablo Borges R. Maricevich, Nivaldo S. Almeida, Hildo Rocha Cirne Azevedo-Filho DOI: 10.33962/roneuro-2020-063 Romanian Neurosurgery (2020) XXXIV (1): pp. 405-410 DOI: 10.33962/roneuro-2020-063 www.journals.lapub.co.uk/index.php/roneurosurgery Ventriculoperitoneal shunt occlusion and cranioplasty. A case report Lívio Pereira de Macêdo1, Arlindo Ugulino Netto1, Juan Pablo Borges Rodrigues Maricevich2, Nivaldo S. Almeida1, Hildo Rocha Cirne Azevedo-Filho1 1 Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, BRAZIL 2 Department of Plastic Surgery, Hospital da Restauração, Recife, Pernambuco, Brazil ABSTRACT Keywords Decompressive craniectomy (DC) is an urgent neurosurgical procedure, effective in cranioplasty, the reduction of intracranial pressure (ICP) in patients with elevated ICP and in VPS, complications of brain infarction that do not respond to clinical treatment; traumatic VPS Occlusion brain injury (TBI); intracerebral haemorrhage (ICH) and aneurysmal intracerebral haemorrhage. Symptomatic hydrocephalus is present in 2 to 29% of patients who undergo craniectomy. They may require a ventriculoperitoneal shunt (VPS). The literature does not yet show standard management of cranioplasty in patients who have previously undergone a shunt, showing evidence of sinking skin flap syndrome. This case shows parenchymal expansion after VPS occlusion and cranioplasty in the Corresponding author: Lívio Pereira de Macêdo patient’s profile. The 23-year-old male patient, right-handed, went to the hospital in January 2017 due to severe traumatic brain injury following multiple traumas. The Department of Neurosurgery, patient underwent urgent DC surgery for the management of elevated ICP.
    [Show full text]
  • Relevant Code and Sample Claim Form Guide
    RELEVANT CODE AND SAMPLE CLAIM FORM GUIDE June 2020 Edition INDICATION SPINRAZA® (nusinersen) is indicated for the treatment of spinal muscular atrophy (SMA) in pediatric and adult patients. SELECTED IMPORTANT SAFETY INFORMATION Coagulation abnormalities and thrombocytopenia, including acute severe thrombocytopenia, have been observed after administration of some antisense oligonucleotides. Patients may be at increased risk of bleeding complications. Please see additional Important Safety Information on page 11 and accompanying full Prescribing Information. INTRODUCTION This guide provides an overview of best practices to assist with coding for procedures related to SPINRAZA administration and ancillary services (if needed). It also provides examples of claim forms and guidance on how to complete them. For a more comprehensive presentation of applicable codes and claim forms, refer to the Guide to SPINRAZA Reimbursement, available at SPINRAZA-hcp.com or through your Biogen representative. ALWAYS CHECK YOUR PATIENT’S PLAN FOR COVERAGE AND CODING GUIDANCE Remember, coding and billing recommendations may vary by payer. Your practice or facility should check directly with the patient’s payer(s) for guidance on the appropriate codes to use to facilitate claim processing for SPINRAZA, its administration, and any ancillary services. Biogen field representatives are available to answer questions and further support the reimbursement process. LINKS TO IMPORTANT RESOURCES Regarding Medicare Parts A and B, coverage for SPINRAZA administration is determined through an LCD. For links to LCDs for MACs in your state, visit the CMS website at www.cms.gov/Medicare/Coverage/DeterminationProcess/LCDs. A map of MACs can be found at www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.
    [Show full text]
  • Public Use Data File Documentation
    Public Use Data File Documentation Part III - Medical Coding Manual and Short Index National Health Interview Survey, 1995 From the CENTERSFOR DISEASECONTROL AND PREVENTION/NationalCenter for Health Statistics U.S. DEPARTMENTOF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics CDCCENTERS FOR DlSEASE CONTROL AND PREVENTlON Public Use Data File Documentation Part Ill - Medical Coding Manual and Short Index National Health Interview Survey, 1995 U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, Maryland October 1997 TABLE OF CONTENTS Page SECTION I. INTRODUCTION AND ORIENTATION GUIDES A. Brief Description of the Health Interview Survey ............. .............. 1 B. Importance of the Medical Coding ...................... .............. 1 C. Codes Used (described briefly) ......................... .............. 2 D. Appendix III ...................................... .............. 2 E, The Short Index .................................... .............. 2 F. Abbreviations and References ......................... .............. 3 G. Training Preliminary to Coding ......................... .............. 4 SECTION II. CLASSES OF CHRONIC AND ACUTE CONDITIONS A. General Rules ................................................... 6 B. When to Assign “1” (Chronic) ........................................ 6 C. Selected Conditions Coded ” 1” Regardless of Onset ......................... 7 D. When to Assign
    [Show full text]
  • Transcranial Doppler for Monitoring and Evaluation of Idiopathic Intracranial Hypertension
    Published online: 2020-05-02 THIEME Original Article 309 Transcranial Doppler for Monitoring and Evaluation of Idiopathic Intracranial Hypertension Pradeep R1 Dhananjay Gupta1 Nikith Shetty2 Anjani Kumar Bhushan1 Krishna Haskar1 Sujana Gogineni1 Anish Mehta1 Mahendra Javali1 Purshottam T. Acharya1 Rangasetty Srinivasa1 1Department of Neurology, Ramaiah Medical College, Bengaluru, Address for correspondence Dhananjay Gupta, MD, Department of Karnataka, India Neurology, Ramaiah Medical College and Hospitals, New BEL Road, 2Department of Neurology, Kasturba Medical College, Manipal, M S Ramaiah Nagar, MSRIT Post,Bengaluru 560054, Karnataka, India Karnataka, India (e-mail: [email protected]). J Neurosci Rural Pract 2020;11:309–314 Abstract Background Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, characterized by features of raised intracranial pressure (ICP). Existing literature is inconclusive about the role of transcranial Doppler (TCD) in the management of IIH. Objective To study the TCD changes in IIH patients, pre- and post-cerebrospinal fluid (CSF) drainage. Materials and Methods This was a prospective study, conducted between July 2017 and December 2019, in a tertiary care referral center in South India. Sixteen consec- utive patients, suspected to have IIH, underwent magnetic resonance imaging ofthe brain, a baseline TCD, and lumbar puncture with CSF drainage and pressure moni- toring. Post-CSF drainage, TCD was repeated and mean flow velocities, peak systolic velocities, end-diastolic velocities, and pulsatility index (PI), in the middle cerebral artery (MCA), vertebral artery, and basilar artery (BA) were noted. Thirteen patients had elevated CSF pressure, and fulfilled the diagnostic criteria for IIH. These patients were included in the final analysis and pre- and post-CSF drainage TCD blood flow velocities and PI were compared.
    [Show full text]
  • Lumbar Puncture
    A fact sheet for patients and carers Lumbar puncture This fact sheet provides information on lumbar punctures. Our fact sheets are designed as general introductions to each subject and are intended to be concise. Each person is affected differently and you should speak with your doctor or specialist for individual advice. What is a lumbar puncture? A lumbar puncture involves extracting some of the fluid that surrounds your brain and spine (known as cerebrospinal fluid or CSF). It is sometimes referred to as a spinal tap. Often, a lumbar puncture is done because doctors need to do some tests on the CSF to help them make a diagnosis. Doctors may look for changes in the fluid that could indicate infection or bleeding, or unusual or uncommon cells that could be a sign of a neurological disorder. They will also check the pressure of the CSF. Less frequently, a lumbar puncture can be done as a means of treatment if a person has too much CSF, and the pressure of the fluid around the brain and spine is too high. What happens before a procedure? A lumbar puncture is likely to take 30 minutes to an hour, so you don’t usually have to stay in hospital overnight. There is no need to stop eating and drinking before the procedu re, and you should continue to take any medication as prescribed, unless you have been told otherwise by your doctor. If you are taking any medication to thin your blood (anticoagulants) it is important that you inform the hospital before your appointment.
    [Show full text]
  • Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: a Narrative Review
    life Review Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review Geraint J. Sunderland 1,2,*, Michael D. Jenkinson 2,3, Elizabeth J. Conroy 4, Carrol Gamble 4 and Conor L. Mallucci 1,5 1 Department of Paediatric Neurosurgery, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool L12 2AP, UK; [email protected] 2 Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; [email protected] 3 Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK 4 Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, L69 3GL, UK; [email protected] (E.J.C.); [email protected] (C.G.) 5 Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7TX, UK * Correspondence: [email protected] Abstract: The prevalence of idiopathic intracranial hypertension (IIH), a complex disorder, is in- creasing globally in association with obesity. The IIH syndrome occurs as the result of elevated intracranial pressure, which can cause permanent visual impairment and loss if not adequately managed. CSF diversion via ventriculoperitoneal and lumboperitoneal shunts is a well-established strategy to protect vision in medically refractory cases. Success of CSF diversion is compromised by high rates of complication; including over-drainage, obstruction, and infection. This review outlines currently used techniques and technologies in the management of IIH. Neurosurgical CSF diversion Citation: Sunderland, G.J.; is a vital component of the multidisciplinary management of IIH. Jenkinson, M.D.; Conroy, E.J.; Gamble, C.; Mallucci, C.L. Keywords: idiopathic intracranial hypertension; pseudotumour cerebri; cerebrospinal fluid; ventricu- Neurosurgical CSF Diversion in loperitoneal shunt; lumboperitoneal shunt; programmable valve; anti-siphon device; neurosurgery Idiopathic Intracranial Hypertension: A Narrative Review.
    [Show full text]