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World Journal of Emergency Medicine 2016年第3期7卷 173-177页

作者： shadi lahham priel schmalbach sean p.wilson lori ludeman mohammad subeh jocelyn chao nadeem albadawi niki mohammadi john c.fox Emergency Medicine University of California Irvine Orange California 92868 USA

BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture(LP).METHODS: This was a prospective, randomized controlled trial comparing POCUS preprocedure identifi cation of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care ***: A total of 158 patients were enrolled. No signifi cant difference was found in time to completion, needle re-direction, or needle re-insertion when using POCUS when compared to the traditional method of ***: Consistent with fi ndings of previous studies, our data indicate that there was no observed benefi t of using POCUS to identify pre-procedure landmarks when performing an LP.

关键词： Ultrasound lumbar puncture Spinal tap

Attitudes and Practices of lumbar puncture among Students, Interns, and Residents of the Pediatric Department of the Mohammed VI University Hospital Center of Oujda, Morocco

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Open Journal of Pediatrics 2024年第3期14卷 598-608页

作者： Hasnae Elhaddadi Ayyad Ghanam Hind Zahiri Amal Hamami Aziza Elouali Abdeladim Babakhouya Maria Rkain Department of Pediatrics University Hospital Center Mohammed VI Oujda Morocco Faculty of Medicine and Pharmacy Mohammed First University Oujda Morocco

Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and practices of students, interns, and residents about LP, and to assess their feelings about how this procedure is taught. Materials and Methods: We conducted a cross-sectional study of 160 participants, using an anonymous questionnaire, to evaluate the attitudes and practices of students, interns and residents in the pediatrics department concerning lumbar puncture. Results: Half of the participants had never performed LP, usually because of the risk involved or lack of confidence, while 20% had performed it more than 4 times. None of the participants had learned to perform the procedure through simulation sessions, while (42%) had learned it under the supervision of a senior physician and had not been able to perform it successfully the first time. Most participants inform the patient about the procedure before performing it. Only 44% of participants acknowledged that LP can be performed under local anesthetic. The sitting position (60%) was by far the most commonly used. Most LPs were performed for diagnostic purposes. Most participants stated that the pediatric ward and the pediatric emergency department are among the departments that perform LP most frequently, and that they would be interested in taking part in simulated lumbar puncture sessions in children in the future. Conclusion: The results of our study show that LP is perceived by students as a risky procedure that is difficult to perform. Teachers should reconsider how this technical procedure is taught, by integrating simulation on mannequins into student training.

关键词： lumbar puncture Learning Healthcare Simulation Stress Clinical Competency

Role of lumbar puncture in clinical outcome of suspected acute bacterial meningitis

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World Journal of Neurology 2023年第4期9卷 37-43页

作者： Arunava Saha Shihla Shireen Kanamgode Sarat Chandra Malempati Sirshendu Chaudhuri Jeffrey Scott Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Assistant Professor Indian Institute of Public HealthHyderabad 500030TelanganaIndia Department of Pulmonary and Critical Care Medicine Saint Vincent HospitalWorcesterMA 01608United States

BACKGROUND Meningitis remains a significant source of mortality and morbidity,with an incidence of 1 per 100000 persons in the United *** recommend obtaining blood cultures and cerebrospinal fluid(CSF)studies in patients presenting with acute meningitis syndrome,and beginning treatment with broad spectrum antibiotics based on the age and certain predisposing *** some patients however,the diagnostic lumbar puncture(LP)is not performed due to a multitude of reasons,ranging from increased intracranial pressure to failed *** such situations,appropriate therapy is initiated empirically and often continued without establishment of a definitive *** To determine whether a diagnostic LP in acute meningitis syndrome was associated with a better outcome and less duration of antibiotic therapy,along with potential causes for deferral of *** A retrospective study was conducted amongst the patients presenting to a 360 bedded community hospital in central Massachusetts with a diagnosis of acute meningitis syndrome between January 2010-September *** electronic health records were accessed to collect necessary demographic and clinical data,including etiology of meningitis,lumbar puncture results,reason for procedure deferral,duration of antibiotic therapy and clinical *** patients were subsequently divided into two groups based on whether they received a LP or not,and data was *** A total of 169 patients admitted with acute meningitis syndrome between September 2010-2022 were included in the *** mean age of the participants was 54.3 years(SD+/-19.2 years).LP was performed for 130(76.9%)participants,out of which,28(21.5%)showed some growth in CSF *** most commonly identified organism was streptococcus *** the 39 patients in whom LP was deferred,the major reasons recorded were:Body habitus(n=6,15.4%),and unsuccessful attempt(n=4,10.3%).While 93(71.5%)patients with LP received

关键词： Meningitis Acute meningitis syndrome lumbar puncture CSF analysis Acute bacterial meningitis Suspected meningitis

Predictors of performing a lumbar puncture in febrile neonates:A hospital-based cohort study

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Predictors of performing a lumbar puncture in febrile neonat...

Computerized modified paramedian approach technique versus conventional midline approach technique of lumbar puncture:a randomized control trial protocol

2018年浙江省医学会妇产科学与围产医学学术年会暨2018年浙江省医师协会妇产科医师分会学术年会

作者： Can-Can Li Tian-Ming Yuan Hui-Min Yu Department of Neonatology Children’s HospitalZhejiang University School of Medicine

Objectives:Neonatal infants with fever were more likely to undergo invasive procedures like lumbar puncture(LP).To provide the evidence of LP related with febrile neonates in the clinic,we discussed the risk factors of abnormal cerebrospinal fluid(CSF) test for febrile ***:A retrospective cohort study was conducted on 566 febrile neonates with *** characteristics were compared and non-conditional logistic regression analysis was performed to determine independent predictors for LP with abnormal CSF test in febrile ***:There were 146(25.80%) cases of abnormal CSF test in febrile *** logistic regression analysis,the following factors independently predicted abnormal CSF test in febrile neonates:enterovirus infection[odds ratio(OR):4.652;95% confidence interval(CI):2.254-12.248],highest temperature>38.35℃(OR:2.948;95% CI:1.733-5.014),age of onset≤9.5 days(OR:2.341;95%CI:1.435-3.831),positive blood culture(OR:2.163;95%CI:1.327-3.678),premature rupture of membrane(OR:2.088;95%CI:1.245-3.496),prior antibiotic use≤1.5 days(OR:1.898;95%CI:1.278-2.819) and duration of fever>3.5 days(OR:1.072;95%CI:1.021-1.125).Conclusion:The factors which may predict the risk of abnormal CSF test in febrile neonates were enterovirus infection,highest temperature>38.35 ℃,age of onset≤9.5 days,positive blood culture,premature rupture of membrane,prior antibiotic use≤1.5 days and duration of fever>3.5 *** data indicated that LP should be routinely considered in the high risk febrile neonates.

关键词： lumbar puncture neonate febrile risk factor,cerebrospinal fluid

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Computerized modified paramedian approach technique versus c...

Intervention at an early threshold for post-hemorrhagic ventricular dilatation in preterm infants: a systematic review and meta-analysis

第十八届中国医师协会神经外科医师年会

作者：林绮盈钟思琪陈以泽陈怡欣雷丁庄源东福建医科大学附属协和医院神经外科

目的 The conventional lumbar puncture(LP) technique is the midline approach technique(MAT).Recently, a new approach called Computerized modified paramedian approach technique(CMPAT) has been ***,the aim of this study is to discuss a randomized controlled trial(RCT) protocol to compare the effects of CMPAT and MAT in patients.方法 We will conduct a prospective, multicentre *** study will recruit 84 patients aged 18–99 years who require *** will be randomly assigned to either the CMPAT treatment group or the MAT treatment *** primary outcome measure will be the number of needle insertion attempts required for a successful *** outcomes will include the puncture success rate,pain assessment and complications.结果 The results of this study will show the difference between CMPAT and MAT.结论 The prospective,multicentre RCTwill inform the clinicians of the difference between CMPAT and MATand provide reference for the selection of lumber puncture.

关键词： Computerized modified paramedian approach technique Midline approach technique Randomized controlled trial lumbar puncture

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World Journal of Pediatrics 2024年第8期20卷 774-786页

作者： Patrick Blundell Lloyd Abood Mallinath Chakraborty Sujoy Banerjee Regional Neonatal Intensive Care Unit University Hospital of WalesCardiffUK Neonatal Unit Singleton HospitalSwanseaSA28QAUK Centre for Medical Education School of MedicineCardiff UniversityCardiffUK

Background Very few adequately powered studies exploring early thresholds for intervention in the management of post-hemorrhagic ventricular dilatation(PHVD)in preterm infants have identified consistent neurodevelopmental advantages at 12–30 *** aimed to conduct a meta-analysis on the efficacy and safety of early versus conservative thresholds for intervention,primarily aimed at normalizing cerebrospinal fluid(CSF)pressure,in the management of PHVD in preterm *** Multiple databases were searched for eligible papers,and prospective randomized trials involving preterm infants were *** results are expressed as relative risks(RRs)with 95%confidence intervals(CIs).The main outcome was survival without moderate-to-severe neurodevelopmental impairment at 12–30 *** Ten articles representing seven randomized trials comparing early versus conservative thresholds for interventions were *** trials(n=545 infants)reported no difference in the main outcome between early and conservative groups[RR 0.99(0.71,1.37)].Sensitivity analysis excluding data from a medication trial did not alter the main outcome[RR 1.15(0.95,1.39)].Infants in the early threshold group received significantly more interventions[RR 1.48(1.05,2.09)].Deaths before discharge/during the initial study period[RR 1.04(0.70,1.54)]or a composite of death or shunt insertion[RR 1.04(0.86,1.27)]were comparable between the two *** Early intervention for PHVD,before a clinical or ultrasound threshold is met,leads to additional clinical procedures but does not improve survival without moderate–severe neurodevelopmental impairment at 12–30 *** should be exercised in interpreting these results due to significant variation between the studies.

关键词： Hydrocephalus Intraventricular hemorrhage lumbar puncture Mortality Neurodevelopment Preterm infants

The clinical analysis of three methods in the treatment of intracranial bacterial infection

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Journal of Pharmaceutical Analysis 2009年第4期21卷 263-266页

作者： Rui-zhi Wang,Wei Shi Department of Neurosurgery,the Second Affiliated Hospital,Medical School of Xi’an Jiaotong University,Xi’an 710004,China Department of Neurosurgery Second Affiliated Hospital Medical School of Xi'an Jiaotong University Xi'an 710004 China

Objective To analyze the effect of three therapeutic methods to find an optimal approach to the treatment of intracranial bacterial infection by retrospectively reviewing 33 intracranial bacterial infection patients who were admitted from 1995 to 2008 in our *** The treatments by intermittent lumbar puncture,continuous lumbar subarachnoid space drainage,and embedment of Ommaya cyst for continuous drainage from the ventricles were performed in 15 cases,12 cases,and 6 cases respectively along with intravenous application of full dose of *** Nineteen cases were cured and the best prognosis was from the group of Ommaya cyst embedment and continuous drainage from the *** Management goals are prompt recognition of the central nervous system(CNS)infection,rapid identification of causative organisms and initiation of treatment with the optimal management methods for *** of Ommaya cyst for continuous drainage from the ventricle is a safe and effective treatment for intracranial bacterial infection.

关键词： intracranial bacterial infection lumbar puncture cerebrospinal fluid(CSF) Ommaya cyst

Management of Idiopathic Chronic Hydrocephalus of the Adult in Guinea: A Prospective Study in 16 Patients

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Open Journal of Modern Neurosurgery 2021年第4期11卷 272-280页

作者： Alpha Boubacar Bah Ibrahima Sory Souare Ibrahima Berete Seylan Diawara Hugues Ghislain Atatla Aboubacar M’mah Camara Mamadou Khaira Bah Luc Kezely Beavogui Service de Neurochirurgie H&#244 pital National Donka Conakry Guinea Service de Neurochirurgie H&#244 pital de l’Amitié Sino-Guinéenne de Kipé Conakry Guinea

Object: Incidence of Idiopathic chronic hydrocephalus of the adult (ICHA) is increasing in Guinea due to the aging of the population. The goal of this study was to describe its epidemiology, clinical presentation, and surgical outcome in a low-resource medical environment. Method: Sixteen patients operated for a probable ICHA were prospectively studied according to a uniform protocol from June 2019 to December 2020. On computerized tomography, all operated patients had a clinical triad of gait disturbance, incontinence, dementia associated with ventriculomegaly, and transependymal edema. In addition, all patients underwent a single lumbar tap, improved clinically, and were subsequently offered a shunt consisting of a simple catheter in 37.5% and a non-adjustable high-pressure valve in 62.5%. Result: The mean age was 68.31 ± 10.4 (range 49 - 89). The sex ratio H/F was 1.67/1. Clinically, the most frequent comorbidity was a combination of hypertension and diabetes in 56.5% of cases. The mean time to diagnosis was 8.31 ± 2.75 months (range 3 - 14). The immediate postoperative mortality was 12.5% from a status epilepticus and pulmonary sepsis. In addition, we observed 2 cases of chronic subdural hematoma (12.5%) and 2 cas

关键词： Idiopathic Normal Pressure Hydrocephalus Comorbidities Ventriculoperitoneal Shunt lumbar puncture

Post Dural puncture Headache—Review and Suggested New Treatment

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Open Journal of Anesthesiology 2016年第9期6卷 148-163页

作者： Sharon L. Kracoff Vladimir Kotlovker Department of Anesthesiology Kaplan Medical Center Rehovot Israel Department of Anesthesiology Soroka University Medical Center Beer-Sheva Israel

Objectives: After reading this article, readers should be able to recognize Post Dural puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.

关键词： Post Dural puncture Headache lumbar puncture Epidural Anesthesia Spinal Anesthesia Headache Hyperbaric Oxygen Therapy

Idiopathic Intracranial Hypertension without Papilloedema “Case Report”

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Open Journal of Ophthalmology 2022年第2期12卷 170-179页

作者： Esraa M. A. Abdullah Mona AL-Saleh Mohammed Abdulrahman Albahar Eye Center Ibn Sina Hospital Kuwait City Kuwait

Purpose: The purpose of this case report is to share and spread the awareness of diagnosing and managing idiopathic intracranial hypertension in atypical scenarios as in this case, who presented with multiple other medical conditions, and had no papilloedema. The presenting signs and symptoms of mere headache were misleading. The other medical conditions could have explained the patient’s headache. These included cervical spine osteoporosis, and middle ear otolith disease. This case is unique because she was found to have IIH without papilloedema, and despite having multiple cancers in the uterus, breasts, and recently the thyroid, she had no malignant cells in the CSF. The patient was treated for IIH, and her malignancies were treated separately by the corresponding physicians. Method: The patient was assessed in 2019, and was followed up closely till 2021, in collaboration with her neurologist, oncologist, and orthopedist. Result: The patient had IIH after her neurologist attempted a lumbar puncture, which showed high CSF pressure. Conclusion: Headache is a common symptom presented by patients of different ages and backgrounds. The absence of papilloedema does not exclude the diagnosis of IIH. When possible etiologies for headache are ruled out (e.g. middle and inner ear infections, anemia, intracranial tumors, glaucoma, etc.), chronic headaches that do not respond to medications, and present with visual field changes may require a lumbar puncture.

关键词： Idiopathic Intracranial Hypertension Papilloedema lumbar puncture Case Report