Ventriculoperitoneal Shunts in the Emergency Department: a Review
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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. -
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). -
Hydrocephalus and Shunts
Hydrocephalus and Shunts Information for patients 2 What is hydrocephalus? The brain is surrounded by fluid, called CSF - Cerebrospinal fluid. The CSF provides some protection for the brain. The brain makes CSF in special fluid-filled spaces called ventricles. The ventricles link to each other by a system of channels through which the CSF flows and eventually leaves to surround the whole brain and spinal cord. The CSF is then taken back into the blood-stream by special channels beside the major veins on the inside of the skull. These are called arachnoid granulations. Figure 1 - Diagram of the brain showing normal CSF pathways 3 Hydrocephalus is a condition in which the CSF builds up within the brain. There are a number of causes of this: 1. The fluid pathways may be blocked or narrowed so that fluid cannot flow adequately. The causes of this blockage can include scarring, a variation in the development of the fluid pathways (present from birth) or sometimes by a tumour which blocks the CSF flow. 2. Sometimes the fluid collection channels (arachnoid granulations) can become blocked and stop working - in a similar manner to how leaves can block a drain. This can happen following an infection or a bleed (haemorrhage). As a result of this block in fluid flow, CSF builds up inside the brain, resulting in an increase in pressure. As a result of this patients most commonly report symptoms of headaches, nausea and vomiting, but problems with balance and short term memory have also been reported. There is another group of patients who do not fit into the patterns described above. -
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. -
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. -
Transjugular Intrahepatic Portosystemic Stent-Shunt In
Guidelines Transjugular intrahepatic portosystemic stent-shunt in Gut: first published as 10.1136/gutjnl-2019-320221 on 29 February 2020. Downloaded from the management of portal hypertension Dhiraj Tripathi ,1,2,3 Adrian J Stanley ,4 Peter C Hayes ,5 Simon Travis,6 Matthew J Armstrong ,1,2,3 Emmanuel A Tsochatzis ,7 Ian A Rowe ,8 Nicholas Roslund,9 Hamish Ireland ,10 Mandy Lomax,11 Joanne A Leithead,12 Homoyon Mehrzad,13 Richard J Aspinall ,14 Joanne McDonagh,1 David Patch7 For numbered affiliations see ABSTRact ► In secondary prevention of oesophageal end of article. These guidelines on transjugular intrahepatic variceal bleeding, TIPSS can be considered portosystemic stent- shunt (TIPSS) in the management where patients rebleed despite combination of Correspondence to of portal hypertension have been commissioned by the VBL +NSBB taking into account the severity Dr Dhiraj Tripathi, Liver Unit, University Hospitals Birmingham Clinical Services and Standards Committee (CSSC) of of rebleeding and other complications of portal NHS Foundation Trust, the British Society of Gastroenterology (BSG) under the hypertension, with careful patient selection Birmingham B15 2TH, UK; auspices of the Liver Section of the BSG. The guidelines to minimise hepatic encephalopathy (weak d. tripathi@ bham. ac. uk are new and have been produced in collaboration with recommendation, moderate- quality evidence). Received 2 November 2019 the British Society of Interventional Radiology (BSIR) Further large controlled trials are required to Revised 20 January 2020 and British Association of the Study of the Liver (BASL). investigate the role of TIPSS as first- line therapy Accepted 22 January 2020 The guidelines development group comprises elected in secondary prevention (strong recommenda- members of the BSG Liver Section, representation tion, low quality of evidence). -
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. -
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. -
Ventriculoperitoneal Shunt-Associated Ascites: a Case Report
Open Access Case Report DOI: 10.7759/cureus.8634 Ventriculoperitoneal Shunt-Associated Ascites: A Case Report Saud E. Suleiman 1, 2 , Anastasia Tambovtseva 3 , Elena Mejery 4 , Ziad Suleiman 5 , Ziad Alaidy 6 1. Gastroenterology, Florida State University (FSU) College of Medicine, Daytona Beach, USA 2. Advanced Gastroenterology, Halifax Medical Center, Daytona Beach, USA 3. Internal Medicine, Ocala Regional Medical Center, Ocala, USA 4. Internal Medicine, Medical University of the Americas, Jackson, USA 5. Biology, University of Florida, Gainesville, USA 6. Breast Cancer Research, Johns Hopkins Hospital, Baltimore, USA Corresponding author: Ziad Alaidy, [email protected] Abstract A ventriculoperitoneal shunt is a commonly performed procedure that is used to relieve the increased intracranial pressure in patients with hydrocephalus. VP shunt placement is an invasive procedure and carries many complications. Besides common complications like infections or mechanical obstruction, VP shunt has been found to be associated with the development of ascites in some patients. VP shunt- associated ascites is a very rare complication and only a few cases have been reported in the literature, most of which were in the pediatric population, while adult VP shunt-associated ascites was even rarer. The patient in this case is a 32-year-old female who presented with ascites of unclear etiology. She had a history of VP shunt placement shortly after birth due to central nervous system (CNS) malformation (agenesis of the corpus callosum). Liver pathology, infection, and malignancy were ruled out as potential causes, and ascites was determined to be due to VP shunt drainage. The exact mechanism of development of ascites in these patients is not fully understood and needs to be investigated further to optimize preventative and therapeutic options. -
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. -
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 -
Denver Peritoneo-Venous Shunt in Refractory Ascites
European Review for Medical and Pharmacological Sciences 2017; 21: 3668-3673 Percutaneous implant of Denver peritoneo- venous shunt for treatment of refractory ascites: a single center retrospective study M. PICCIRILLO1, L. RINALDI2, M. LEONGITO1, A. AMORE1, A. CRISPO1, V. GR ANATA 3, P. APREA4, F. IZZO1 1Department of Abdominal Surgical Oncology and Hepatobiliary Unit, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy 2Department of Medical, Surgical, Neurological, Metabolic and Geriatric Science, Campania University “Luigi Vanvitelli”, Naples, Italy 3Department of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy 4Department of Anesthesiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy Abstract. – OBJECTIVE: Refractory ascites List of Abbreviations is defined as a lack of response to high doses of diuretics or the development of diuretic related TIPS: Transjugular intrahepatic portosystemic shunts; side effects, which compel the patient to discon- PVS: Peritoneovenous shunt; OS: Overall survival; HR: tinue the diuretic treatment. Current therapeutic Hazard Ratio; DIC: Disseminated intravascular coagu- strategies include repeated large-volume para- lopathy. centesis and transjugular intrahepatic porto- systemic shunts (TIPS). Peritoneovenous shunt (Denver shunt) should be considered for pa- Introduction tients with refractory ascites who are not candi- dates for paracentesis or TIPS. This study pres- Ascites is the most frequent complication of ents our case series in the implant of Denver cirrhosis and it is related to splanchnic vasodilata- peritoneovenous shunt. tion leading to the development of hyperdynamic PATIENTS AND METHODS: Sixty-two pa- circulation, ineffective volemia and activation of tients underwent percutaneous placement of 1 Denver shunt between November 2003 and Ju- the vasoconstrictor system .