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Alatni RI, Alsamani R, Alqefari A. Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review. Cureus 2024; 16:e52330. [PMID: 38361721 PMCID: PMC10867709 DOI: 10.7759/cureus.52330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.
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Affiliation(s)
| | - Rana Alsamani
- Medicine and Surgery, Qassim University, Qassim, SAU
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Sobot Novakovic S, Rakanovic D, Milic-Radic T. Spinal Introducer Needle Breakage During Spinal Anesthesia for Cesarean Section: A Case Report. Cureus 2023; 15:e46972. [PMID: 38021597 PMCID: PMC10640857 DOI: 10.7759/cureus.46972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Spinal and epidural anesthesia are the preferred choices for patients undergoing a cesarean section (CS). The increased use of neuraxial anesthesia in obstetrics may lead to certain complications such as needle breakage. While several cases of broken spinal and epidural needles have been reported, the exact incidence of needle breakage remains uncertain. The use of pencil-point needles with smaller diameters and the increasing BMI among pregnant individuals may have contributed to the increase in the reported incidents of broken needles during obstetric surgery. We present a case of a patient who was found to have a leftover spinal introducer needle in her back after undergoing spinal anesthesia for CS.
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Affiliation(s)
- Suzana Sobot Novakovic
- Anesthesiology and Critical Care, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Dragan Rakanovic
- Anesthesiology and Critical Care, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Tanja Milic-Radic
- Obstetrics and Gynaecology, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
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Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo C, Lucas DN, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group. Reg Anesth Pain Med 2023:rapm-2023-104817. [PMID: 37582578 DOI: 10.1136/rapm-2023-104817] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH. METHODS Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach. RESULTS Based on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence. CONCLUSIONS These clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients' interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.
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Affiliation(s)
- Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jessica Ansari
- Anesthesia Department, Stanford Health Care, Stanford, California, USA
| | - Zafeer Baber
- Department of Anesthesiology and Perioperative Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Yian Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Kathryn DelPizzo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Dan Sebastian Dirzu
- Anesthesia and Intensive Care, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Narayan R Kissoon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter G Kranz
- Depatement of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa Leffert
- Department of Anesthesiology, Yale New Haven Health System; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Lim
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics & Gynecology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Clara Lobo
- Anesthesiology Institute, Interventional Pain Medicine Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Dominique Nuala Lucas
- Department of Anaesthesia, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital - Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Stephen E Rodriguez
- Department of Anesthesia, Walter Reed Army Medical Center, Bethesda, Maryland, USA
| | - Herman Sehmbi
- Department of Anesthesia, Western University, London, Ontario, Canada
| | - Manuel C Vallejo
- Departments of Medical Education, Anesthesiology, Obstetrics & Gynecology, West Virginia University, Morgantown, West Virginia, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Samer Narouze
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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Philip J, Flores M, Beegle R, Dodson S, Messina S, Murray J. Rates of Epidural Blood Patch following Lumbar Puncture Comparing Atraumatic versus Bevel-Tip Needles Stratified for Body Mass Index. AJNR Am J Neuroradiol 2022; 43:315-318. [PMID: 35027350 PMCID: PMC8985676 DOI: 10.3174/ajnr.a7397] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Postdural puncture headache, a known complication of lumbar puncture, typically resolves with conservative management. Symptoms persist in a minority of patients, necessitating an epidural blood patch. One method of decreasing rates of postdural puncture headache is using atraumatic, pencil-point needles rather than bevel-tip needles. To the best of our knowledge, this is the first study comparing epidural blood patch rates between pencil- and bevel-tip needles with a subgroup analysis based on body mass index. MATERIALS AND METHODS This single-institution retrospective study identified 4435 patients with a recorded body mass index who underwent a lumbar puncture with a 22-ga pencil-tip Whitacre needle, a 20-ga bevel-tip Quincke needle, or a 22-ga Quincke needle. The groups were stratified by body mass index. We compared epidural blood patch rates between 22-ga pencil-tip Whitacre needles versus 22-ga Quincke needles and 22-ga Quincke needles versus 20-ga bevel-tip Quincke needles using the Fischer exact test and χ2 test. RESULTS Postdural puncture headache necessitating an epidural blood patch was statistically more likely using a 22-ga Quincke needle in all patients (P < .001) and overweight (P = .03) and obese (P < .001) populations compared with using a 22-ga pencil-tip Whitacre needle. In the normal body mass index population, there was no statistically significant difference in epidural blood patch rates when using a 22-ga pencil-tip Whitacre needle compared with a 22-ga Quincke needle (P = .12). There was no significant difference in epidural blood patch rates when comparing a 22-ga Quincke needle versus a 20-ga bevel-tip Quincke needle in healthy (P = .70), overweight (P = .69), or obese populations (P = .44). CONCLUSIONS Using a 22-ga pencil-tip Whitacre needle resulted in lower epidural blood patch rates compared with a 22-ga Quincke needle in all patients. Subgroup analysis demonstrated a statistically significant difference in epidural blood patch rates in overweight and obese populations, but not in patients with a normal body mass index.
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Affiliation(s)
- J.T. Philip
- From the AdventHealth Medical Group Radiology at Central Florida (J.T.P., M.A.F., R.D.B., S.C.D.), Orlando, Florida
| | - M.A. Flores
- From the AdventHealth Medical Group Radiology at Central Florida (J.T.P., M.A.F., R.D.B., S.C.D.), Orlando, Florida
| | - R.D. Beegle
- From the AdventHealth Medical Group Radiology at Central Florida (J.T.P., M.A.F., R.D.B., S.C.D.), Orlando, Florida
| | - S.C. Dodson
- From the AdventHealth Medical Group Radiology at Central Florida (J.T.P., M.A.F., R.D.B., S.C.D.), Orlando, Florida
| | - S.A. Messina
- Department of Neuroradiology (S.A.M.), Mayo Clinic Rochester, Rochester, Minnesota
| | - J.V. Murray
- Department of Neuroradiology (J.V.M.), Mayo Clinic, Jacksonville, Florida
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Tai CS, Wu SL, Lin SY, Liang Y, Wang SJ, Chen SP. The causal-effect of bed rest and post-dural puncture headache in patients receiving diagnostic lumbar puncture: A prospective cohort study. J Chin Med Assoc 2021; 84:791-794. [PMID: 34074932 DOI: 10.1097/jcma.0000000000000562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture. Patients who received lumbar puncture were previously suggested to remain in bed for a certain time to prevent PDPH; however, this concept was challenged by recent studies. We aimed to investigate whether ambulation instead of resting supine following lumbar puncture could increase the risk of PDPH. METHODS The study used a prospective cohort design, applying convenience sampling among patients who received diagnostic lumbar puncture between January and September 2018 in the neurology ward of a tertiary medical center. The patients who fulfilled the inclusion criteria were informed that the current practice suggests lying supine for 6 to 8 hours after lumbar puncture, but they were allowed to either follow the suggestion or ambulate by their wills. The timing of bed rest was recorded, in addition to other possible risk factors of PDPH. The study endpoint is the presence or absence of PDPH within 48 hours of lumbar puncture. RESULTS A total of 137 patients who received lumbar puncture were enrolled, including 103 with bed rest following lumbar puncture and 34 without. There was no difference in demographics between the two groups. PDPH was found in 21 patients, with a total follow-up period of 5959 person-hours and an incidence density of 0.35%. There was no significant difference between the incidence of PDPH between the two groups (non-bed rest group 5.9% vs bed rest group 18.4%; p = 0.078), nor was incidence density (non-bed rest group 0.13% vs bed rest group 0.43%, p = 0.113). The results remained the same after adjusting for age. CONCLUSION Bed rest following lumbar puncture does not prevent PDPH, and even leads to a marginally increased risk of PDPH. Amendment to the current practice guideline post-lumbar puncture care might be needed to improve patient care.
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Affiliation(s)
- Chien-Shu Tai
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shang-Liang Wu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Yu Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying Liang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
BACKGROUND Postlumbar puncture headache (PLPH) is a common adverse event after lumbar puncture. The specific cause for headache remains uncertain but is assumed to be cerebrospinal fluid leakage. The headache affects the patient, family, and workplace as well as society in general. The aim of this study was to identify risk factors associated with the development of PLPH. METHODS This quantitative case-control study included 285 patients having undergone diagnostic lumbar puncture at a department of infectious diseases during 2015 to 2016. We examined blood glucose and blood albumin levels as well as systolic, diastolic, and mean arterial blood pressure. Statistical analysis included Student t test, χ, and logistic regression. RESULTS Compared with the control group, patients with PLPH tended to have a lower glucose level (5.7 vs 6.4 mmol/L), lower systolic pressure (126 vs 137 mm Hg), and lower mean arterial blood pressure (90 vs 96 mm Hg). Logistic regression analysis showed that lower systolic blood pressure (≤126 mm Hg) significantly increased the risk of PLPH (odds ratio, 0.977 [95% confidence interval, 0.957-0.998]) along with age younger than 40 years (odds ratio, 0.954 [95% confidence interval, 0.935-0.973]). CONCLUSION Patients with a lower systolic blood pressure had a statistically significantly increased risk of PLPH. Furthermore, younger age was also associated with an increased risk of PLPH.
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Cognat E, Koehl B, Lilamand M, Goutagny S, Belbachir A, de Charentenay L, Guiddir T, Zetlaoui P, Roos C, Paquet C. Preventing Post-Lumbar Puncture Headache. Ann Emerg Med 2021; 78:443-450. [PMID: 33966935 DOI: 10.1016/j.annemergmed.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
Post-lumbar puncture headache is the main adverse event from lumbar puncture and occurs in 3.5% to 33% of patients, causing functional and socio-professional disability. We searched the post-lumbar puncture headache literature and, based on this review and personal expertise, identified and addressed 19 frequently asked questions regarding post-lumbar puncture headache risk factors and prevention. Among the nonmodifiable factors, older age is associated with a lower incidence of post-lumbar puncture headache, while female sex, lower body mass index, and history of headache might be associated with increased risk. The use of atraumatic, noncutting needles is the most effective intervention for post-lumbar puncture headache prevention. These needles are not more difficult to use than cutting needles. Other commonly recommended measures (eg, fluid supplementation, caffeine) appear unhelpful, and some (eg, bed rest) may worsen post-lumbar puncture headache.
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Affiliation(s)
- Emmanuel Cognat
- Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France.
| | - Berengère Koehl
- Sickle Cell Disease Center, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Robert Debré, Paris, France
| | - Matthieu Lilamand
- Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France; Sickle Cell Disease Center, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Robert Debré, Paris, France; Département de Gériatrie, Assistance Publique Hôpitaux de Paris, APHP.Nord, Sites Bichat et Bretonneau, Paris, France
| | - Stéphane Goutagny
- Service de Neurochirurgie, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Beaujon, Clichy, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Louise de Charentenay
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Tamazoust Guiddir
- Service de Pédiatrie, Assistance Publique Hôpitaux de Paris, APHP.Sud, Site Bicêtre, Le Kremlin-Bicêtre, France
| | - Paul Zetlaoui
- Service d'Anesthésie-Réanimation, Assistance Publique Hôpitaux de Paris, APHP.Sud, Site Bicêtre, Le Kremlin-Bicêtre, France
| | - Caroline Roos
- Centre d'Urgence des Céphalées, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Paquet
- Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France
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Sjulstad AS, Odeh F, Baloch FK, Berg DH, Arntzen K, Alstadhaug KB. Occurrence of postdural puncture headache-A randomized controlled trial comparing 22G Sprotte and Quincke. Brain Behav 2020; 10:e01886. [PMID: 33047511 PMCID: PMC7749614 DOI: 10.1002/brb3.1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To assess the incidence of postdural puncture headache (PDPH) using 22-gauge atraumatic needle (Sprotte, 22GS) compared with 22-gauge traumatic needle (Quincke, 22GQ). BACKGROUND Diagnostic lumbar puncture (dLP) is commonly complicated by PDPH. Despite evidence to support the use of 22GS, European neurologists seem to keep using 22GQ. METHODS This was a randomized, double-blind study. Adults (age: 18-60 years) scheduled for dLP were included. dLP and CSF acquisition were performed in accordance with highly standardized procedures. Patients were followed up on days 2 and 7. RESULTS In total, 172 patients were randomized and lumbar punctured, and 21 were excluded due to wrong inclusion (n = 11), needle switch (n = 7), failed dLP (n = 1), withdrawal (n = 1), and missed follow-up (n = 1). Among the remaining 151 patients (mean age: 40.7 ± 12.4 years), 77 had dLP using 22GQ and 74 using 22GS. Incidence of PDPH among patients punctured with 22GS (18%) was significantly lower (p = .004) than among patients punctured with 22GQ (39%). Relative risk was 0.45, 95% CI 0.26-0.80. Patients with PDPH had significantly lower weight (p = .035), and there was no significant difference related to age (p = .064), sex (p = .239), height (p = .857), premorbid episodic migraine (p = .829), opening pressure (p = .117), operators (p = .148), amount of CSF removed (p = .205), or number of attempts (p = .623). CONCLUSIONS The use of 22GS halves the risk of PDPH compared with 22GQ. This study provides strong support to make a change in practice where traumatic needles are still in regular use.
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Affiliation(s)
| | - Francis Odeh
- Nordland Hospital Trust, Bodø, Norway.,Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | | | | | | | - Karl B Alstadhaug
- Nordland Hospital Trust, Bodø, Norway.,Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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Tigchelaar C, Absalom AR. Cutting needles versus cutting edge technology. Clin Neurol Neurosurg 2020; 200:106334. [PMID: 33183884 DOI: 10.1016/j.clineuro.2020.106334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Celien Tigchelaar
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Hok-A-Hin YS, Willemse EAJ, Teunissen CE, Del Campo M. Guidelines for CSF Processing and Biobanking: Impact on the Identification and Development of Optimal CSF Protein Biomarkers. Methods Mol Biol 2019; 2044:27-50. [PMID: 31432404 DOI: 10.1007/978-1-4939-9706-0_2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The field of neurological diseases strongly needs biomarkers for early diagnosis and optimal stratification of patients in clinical trials or to monitor disease progression. Cerebrospinal fluid (CSF) is one of the main sources for the identification of novel protein biomarkers for neurological diseases. Despite the enormous efforts employed to identify novel CSF biomarkers, the high variability observed across different studies has hampered their validation and implementation in clinical practice. Such variability is partly caused by the effect of different pre-analytical confounding factors on protein stability, highlighting the importance to develop and comply with standardized operating procedures. In this chapter, we describe the international consensus pre-analytical guidelines for CSF processing and biobanking that have been established during the last decade, with a special focus on the influence of pre-analytical confounders on the global CSF proteome. In addition, we provide novel results on the influence of different delayed storage and freeze/thaw conditions on the CSF proteome using two novel large multiplex protein arrays (SOMAscan and Olink). Compliance to consensus guidelines will likely facilitate the successful development and implementation of CSF protein biomarkers in both research and clinical settings, ultimately facilitating the successful development of disease-modifying therapies.
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Affiliation(s)
- Yanaika S Hok-A-Hin
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Eline A J Willemse
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marta Del Campo
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
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Abstract
OBJECTIVE Lumbar puncture (LP) is increasingly common in Alzheimer disease research; however, agreement to undergo LP varies. We sought to determine factors influencing LP consent at Alzheimer's Disease Centers (ADCs) in the United States. METHODS A 3-part survey was distributed to each ADC: (1) ADC LP Experience; (2) LP Requestor Experience; and (3) Patient LP Experience (both Initial and Follow-up). In all, 64 LP Requestor, 579 Patient/Initial, and 404 Patient/Follow-up surveys were collected. Logistic regression analyses with generalized estimating equations were used to assess factors associated with LP agreement and post-LP complications. RESULTS Asians and those viewing LP negatively were less likely to agree to LP. Three hundred fifty-two participants had an LP; LP headache occurred in 11.9% (blood patch required in 1.4%) and 9.9% reported other complications. Younger individuals, women, those diagnosed with mild cognitive impairment, use of a Quincke needle, ≤20 mL cerebrospinal fluid drawn, and hemorrhage during LP were associated with LP headache. Use of gravity flow during LP was associated with fewer other complications (nausea, dizziness, vasovagal response, back pain, neck stiffness, and/or nerve root pain). CONCLUSIONS LP in Alzheimer disease research is generally safe and well tolerated. Factors influencing LP agreement potentially could be studied to advance participant acceptance of the procedure.
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Rochwerg B, Almenawer SA, Siemieniuk RAC, Vandvik PO, Agoritsas T, Lytvyn L, Alhazzani W, Archambault P, D'Aragon F, Farhoumand PD, Guyatt G, Laake JH, Beltrán-Arroyave C, McCredie V, Price A, Chabot C, Zervakis T, Badhiwala J, St-Onge M, Szczeklik W, Møller MH, Lamontagne F. Atraumatic (pencil-point) versus conventional needles for lumbar puncture: a clinical practice guideline. BMJ 2018; 361:k1920. [PMID: 29789372 PMCID: PMC6364256 DOI: 10.1136/bmj.k1920] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Per Olav Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine & Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Canada
- CHU de Québec - Université Laval Research Center, CHU de Québec - Université Laval, Université Laval, Québec City, Canada
| | - Frederick D'Aragon
- Faculty of Medicine and Health Sciences Université de Sherbrooke, Sherbrooke, Canada
- Research Centre, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Pauline Darbellay Farhoumand
- Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Jon Henrik Laake
- Department of Anaesthesiology, Division of Emergency and Critical Care, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | | | - Victoria McCredie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, University Health Network, Toronto, Canada
| | - Amy Price
- The BMJ (Research and Evaluation), London, UK
- Department of Continuing Education, University of Oxford, Oxford, UK
| | | | | | - Jetan Badhiwala
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Maude St-Onge
- CHU de Québec - Université Laval Research Center, CHU de Québec - Université Laval, Université Laval, Québec City, Canada
- Centre intégré de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
- Department of Family and Emergency Medicine & Department of Anesthesiology and Critical Care & Faculty of Medicine, Université Laval, Laval, Canada
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Francois Lamontagne
- Faculty of Medicine and Health Sciences Université de Sherbrooke, Sherbrooke, Canada
- Research Centre, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
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13
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Zhang HK, Kim Y, Lin M, Paredes M, Kannan K, Moghekar A, Durr NJ, Boctor EM. Toward dynamic lumbar puncture guidance using needle-based single-element ultrasound imaging. J Med Imaging (Bellingham) 2018; 5:021224. [PMID: 29651451 DOI: 10.1117/1.jmi.5.2.021224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 03/05/2018] [Indexed: 11/14/2022] Open
Abstract
Lumbar punctures (LPs) are interventional procedures that are used to collect cerebrospinal fluid. Since the target window is small, physicians have limited success conducting the procedure. The procedure is especially difficult for obese patients due to the increased distance between bone and skin surface. We propose a simple and direct needle insertion platform, enabling image formation by sweeping a needle with a single ultrasound element at the tip. The needle-shaped ultrasound transducer can not only sense the distance between the tip and a potential obstacle, such as bone, but also visually locate the structures by combining transducer location tracking and synthetic aperture focusing. The concept of the system was validated through a simulation that revealed robust image reconstruction under expected errors in tip localization. The initial prototype was built into a 14 G needle and was mounted on a holster equipped with a rotation shaft allowing one degree-of-freedom rotational sweeping and a rotation tracking encoder. We experimentally evaluated the system using a metal-wire phantom mimicking high reflection bone structures and human spinal bone phantom. Images of the phantoms were reconstructed, and the synthetic aperture reconstruction improved the image quality. These results demonstrate the potential of the system to be used as a real-time guidance tool for improving LPs.
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Affiliation(s)
- Haichong K Zhang
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Younsu Kim
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Melissa Lin
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | - Mateo Paredes
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Karun Kannan
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Abhay Moghekar
- Johns Hopkins University, Department of Neurology, Baltimore, Maryland, United States
| | - Nicholas J Durr
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Emad M Boctor
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Radiology, Baltimore, Maryland, United States
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14
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Nath S, Koziarz A, Badhiwala JH, Alhazzani W, Jaeschke R, Sharma S, Banfield L, Shoamanesh A, Singh S, Nassiri F, Oczkowski W, Belley-Côté E, Truant R, Reddy K, Meade MO, Farrokhyar F, Bala MM, Alshamsi F, Krag M, Etxeandia-Ikobaltzeta I, Kunz R, Nishida O, Matouk C, Selim M, Rhodes A, Hawryluk G, Almenawer SA. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis. Lancet 2018; 391:1197-1204. [PMID: 29223694 DOI: 10.1016/s0140-6736(17)32451-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. METHODS In this systematic review and meta-analysis, we independently searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomised controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication. Randomised trials comparing atraumatic and conventional needles in which no dural puncture was done (epidural injections) or without a conventional needle control group were excluded. We screened studies and extracted data from published reports independently. The primary outcome of postdural-puncture headache incidence and additional safety and efficacy outcomes were assessed by random-effects and fixed-effects meta-analysis. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42016047546. FINDINGS We identified 20 241 reports; after exclusions, 110 trials done between 1989 and 2017 from 29 countries, including a total of 31 412 participants, were eligible for analysis. The incidence of postdural-puncture headache was significantly reduced from 11·0% (95% CI 9·1-13·3) in the conventional needle group to 4·2% (3·3-5·2) in the atraumatic group (relative risk 0·40, 95% CI 0·34-0·47, p<0·0001; I2=45·4%). Atraumatic needles were also associated with significant reductions in the need for intravenous fluid or controlled analgesia (0·44, 95% CI 0·29-0·64; p<0·0001), need for epidural blood patch (0·50, 0·33-0·75; p=0·001), any headache (0·50, 0·43-0·57; p<0·0001), mild headache (0·52, 0·38-0·70; p<0·0001), severe headache (0·41, 0·28-0·59; p<0·0001), nerve root irritation (0·71, 0·54-0·92; p=0·011), and hearing disturbance (0·25, 0·11-0·60; p=0·002). Success of lumbar puncture on first attempt, failure rate, mean number of attempts, and the incidence of traumatic tap and backache did not differ significantly between the two needle groups. Prespecified subgroup analyses of postdural-puncture headache revealed no interactions between needle type and patient age, sex, use of prophylactic intravenous fluid, needle gauge, patient position, indication for lumbar puncture, bed rest after puncture, or clinician specialty. These results were rated high-quality evidence as examined using the grading of recommendations assessment, development, and evaluation. INTERPRETATION Among patients who had lumbar puncture, atraumatic needles were associated with a decrease in the incidence of postdural-puncture headache and in the need for patients to return to hospital for additional therapy, and had similar efficacy to conventional needles. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of atraumatic needles as a superior option for patients who require lumbar puncture. FUNDING None.
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Affiliation(s)
- Siddharth Nath
- Division of Neurosurgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Alex Koziarz
- Division of Neurosurgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Jetan H Badhiwala
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Waleed Alhazzani
- Division of Critical Care, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Roman Jaeschke
- Division of Critical Care, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Sunjay Sharma
- Division of Neurosurgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Laura Banfield
- Health Sciences Library, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Ashkan Shoamanesh
- Division of Neurology and Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Sheila Singh
- Division of Neurosurgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Wieslaw Oczkowski
- Division of Neurology and Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Emilie Belley-Côté
- Division of Critical Care, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Ray Truant
- Department of Biochemistry and Biomedical Sciences, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Kesava Reddy
- Division of Neurosurgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Maureen O Meade
- Division of Critical Care, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence, and Impact, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Jagiellonian University, Krakow, Poland
| | - Fayez Alshamsi
- Department of Internal Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mette Krag
- Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
| | - Itziar Etxeandia-Ikobaltzeta
- Department of Health Research Methods, Evidence, and Impact, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Regina Kunz
- Evidence based Insurance Medicine, University Hospital of Basel, Basel, Switzerland
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew Rhodes
- Department of Anaesthesia and Intensive Care, St George's Hospital, University of London, London, UK
| | - Gregory Hawryluk
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Saleh A Almenawer
- Division of Neurosurgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada.
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15
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on pediatric intracranial hypertension. RECENT FINDINGS The annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population. Pediatric intracranial hypertension is a disorder that if left untreated can lead to poor quality of life and morbidity. There are no current treatment studies in pediatrics, but adult data suggests acetazolamide remains an acceptable first-line medication.
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Affiliation(s)
- Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Amanda L Way
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, OH, USA
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16
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A dedicated lumbar puncture clinic: performance and short-term patient outcomes. J Neurol 2017; 264:2075-2080. [DOI: 10.1007/s00415-017-8597-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
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17
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Engelborghs S, Niemantsverdriet E, Struyfs H, Blennow K, Brouns R, Comabella M, Dujmovic I, van der Flier W, Frölich L, Galimberti D, Gnanapavan S, Hemmer B, Hoff E, Hort J, Iacobaeus E, Ingelsson M, Jan de Jong F, Jonsson M, Khalil M, Kuhle J, Lleó A, de Mendonça A, Molinuevo JL, Nagels G, Paquet C, Parnetti L, Roks G, Rosa-Neto P, Scheltens P, Skårsgard C, Stomrud E, Tumani H, Visser PJ, Wallin A, Winblad B, Zetterberg H, Duits F, Teunissen CE. Consensus guidelines for lumbar puncture in patients with neurological diseases. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 8:111-126. [PMID: 28603768 PMCID: PMC5454085 DOI: 10.1016/j.dadm.2017.04.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction Cerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain. Methods We provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III). Results Our consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications. Discussion When an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.
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Affiliation(s)
- Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Raf Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Receca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irena Dujmovic
- Clinic of Neurology, Clinical Centre of Serbia, Department of Neurology, Faculty of Medicine, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Wiesje van der Flier
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany
| | - Daniela Galimberti
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Granda, IRCCS Ospedale Policlinico, Milan, Italy
| | - Sharmilee Gnanapavan
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Bernhard Hemmer
- Department of Neurology, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Erik Hoff
- Department of Neurology, Atrium Medisch Centrum Parkstad, Heerlen, The Netherlands
| | - Jakub Hort
- Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Frank Jan de Jong
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michael Jonsson
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Michael Khalil
- Department of Neurology, Medical University Graz, Graz, Austria
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Alexandre de Mendonça
- Laboratory of Neurosciences, Department of Molecular Medicine and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - José Luis Molinuevo
- Alzheimer's disease and other cognitive disorders unit, Neurology Service, Hospital Clinic i Universitari, IDIBAPS, Barcelona, Spain
| | - Guy Nagels
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Faculté de Psychologie et des sciences de l'éducation, UMons, Mons, Belgium.,National MS Center Melsbroek, Brussels, Belgium
| | - Claire Paquet
- Research Memory Center Lariboisière Hospital University Paris Diderot INSERMU942, Paris, France
| | - Lucilla Parnetti
- Section of Neurology, Centre for Memory Disturbances, Department of Medicine, University of Perugia, Perugia, Italy
| | - Gerwin Roks
- Department of Neurology, St Elisabeth Ziekenhuis, Tilburg, The Netherlands
| | - Pedro Rosa-Neto
- Departments of Neurology & Neurosurgery and Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada.,Departments of Psychiatry, McGill Centre for Studies in Aging, Douglas Hospital Research Center, McGill University, Montreal, Canada
| | - Philip Scheltens
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hayrettin Tumani
- CSF Laboratory and Multiple Sclerosis Outpatient Unit, Department of Neurology, University of Ulm, Ulm, Germany
| | - Pieter Jelle Visser
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Anders Wallin
- Memory Clinic, Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,UCL Institute of Neurology, Department of Molecular Neuroscience, London, United Kingdom
| | - Flora Duits
- Alzheimer center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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18
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Effect of spinal needle characteristics on measurement of spinal canal opening pressure. Am J Emerg Med 2017; 35:769-772. [PMID: 28258839 DOI: 10.1016/j.ajem.2017.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/10/2017] [Accepted: 01/23/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE A wide variety of spinal needles are used in clinical practice. Little is currently known regarding the impact of needle length, gauge, and tip type on the needle's ability to measure spinal canal opening pressure. This study aimed to investigate the relationship between these factors and the opening-pressure measurement or time to obtain an opening pressure. METHODS Thirteen distinct spinal needles, chosen to isolate the effects of length, gauge, and needle-point type, were prospectively tested on a lumbar puncture simulator. The key outcomes were the opening-pressure measurement and the time required to obtain that measure. Pressures were recorded at 10-s intervals until 3 consecutive, identical readings were observed. RESULTS Time to measure opening pressure increased with increasing spinal needle length, increasing gauge, and the Quincke-type (cutting) point (P<0.001 for all). The time to measurement ranged from 30s to 530s, yet all needle types were able to obtain a consistent opening pressure measure. CONCLUSION Although opening pressure estimates are unlikely to vary markedly by needle type, the time required to obtain the measurement increased with increasing needle length and gauge and with Quincke-type needles.
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19
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Tian W, Zhang J, Chen J, Liu Y, Chen X, Wang N. A quantitative study of intracranial hypotensive syndrome by magnetic resonance. Clin Neurol Neurosurg 2015; 141:71-6. [PMID: 26745515 DOI: 10.1016/j.clineuro.2015.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/03/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study aims to investigate the magnetic resonance imaging (MRI) findings of intracranial hypotension syndrome (IHS) and the change of quantitative indicators, so as to yield a deeper understanding of the disease. PATIENTS AND METHODS The clinical data and MRI findings of 26 cases of IHS which were confirmed by lumbar puncture were retrospectively analyzed. Two physicians evaluated the MRI findings including thickening and enhancement of dural, pituitary enlargement, subdural effusion (hematocele), venous engorgement and brain sagging, and measured the quantitative indicators including mamillopontine distance and pontomesencephalic angle. The consistency between the two results of the physicians was assessed by Kappa consistency test. The differences of mamillopontine distance and pontomesencephalic angle between the patient group and the control group were determined by paired t-test. The diagnostic efficiency of mamillopontine distance and pontomesencephalic angle was assessed by area under the ROC curve, and their best diagnostic thresholds were also determined, respectively. Age- and sex-matched healthy volunteers controls (n=26) were recruited and served as the control group. RESULTS All of the 26 patients suffered from the characterized by orthostatic headache of IHS. The clinical evaluations of dural thickening and enhancement, pituitary enlargement, subdural effusion (hematocele), venous engorgement by the two physicians showed excellent agreements (κ=0.808, 1 and 0.906, P<0.01), and the clinical evaluations of brain sagging showed medium agreements (κ=0.606, P<0.01). The mamillopontine distance and pontomesencephalic angle of the patient group were 5.4 ± 1.6mm and 47.8 ± 8.7°, respectively, which were obviously less than those of the control group (6.9 ± 1.1mm and 61.0 ± 6.1°, respectively), and the differences were statistically significant (t=-4.563, P<0.01; t=-.329, P<0.01). The area under ROC curve of mamillopontine distance and pontomesencephalic angle were 0.774 and 0.908, respectively, and the diagnostic value of pontomesencephalic angle was higher than that of the mamillopontine distance. The sensitivity and specificity were 73.1% and 73.1%, respectively, when diagnostic threshold of mamillopontine distance was 6.4mm. The sensitivity and specificity were 76.9% and 96.2%, when diagnostic threshold of pontomesencephalic angle was 51.7°. CONCLUSION The MRI findings presented characteristic features of IHS. The quantitative indicators including mamillopontine distance and pontomesencephalic angle were helpful for clinical diagnosis of subjective findings of IHS.
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Affiliation(s)
- Weizhong Tian
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Ji Zhang
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China.
| | - Jinhua Chen
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Ying Liu
- Department of Neurology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Xiaoyun Chen
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Ning Wang
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
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