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Journal articles on the topic 'Lumbar Puncture'

Author: Grafiati

Published: 4 June 2021

Last updated: 6 September 2023

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1

Yiangou, Andreas, James Mitchell, Keira Annie Markey, William Scotton, Peter Nightingale, Hannah Botfield, Ryan Ottridge, Susan P. Mollan, and Alexandra J. Sinclair. "Therapeutic lumbar puncture for headache in idiopathic intracranial hypertension: Minimal gain, is it worth the pain?" Cephalalgia 39, no. 2 (June 17, 2018): 245–53. http://dx.doi.org/10.1177/0333102418782192.

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Background Headache is disabling and prevalent in idiopathic intracranial hypertension. Therapeutic lumbar punctures may be considered to manage headache. This study evaluated the acute effect of lumbar punctures on headache severity. Additionally, the effect of lumbar puncture pressure on post-lumbar puncture headache was evaluated. Methods Active idiopathic intracranial hypertension patients were prospectively recruited to a cohort study, lumbar puncture pressure and papilloedema grade were noted. Headache severity was recorded using a numeric rating scale (NRS) 0–10, pre-lumbar puncture and following lumbar puncture at 1, 4 and 6 hours and daily for 7 days. Results Fifty two patients were recruited (mean lumbar puncture opening pressure 32 (28–37 cmCSF). At any point in the week post-lumbar puncture, headache severity improved in 71% (but a small reduction of −1.1 ± 2.6 numeric rating scale) and exacerbated in 64%, with 30% experiencing a severe exacerbation ≥ 4 numeric rating scale. Therapeutic lumbar punctures are typically considered in idiopathic intracranial hypertension patients with severe headaches (numeric rating scale ≥ 7). In this cohort, the likelihood of improvement was 92% (a modest reduction of headache pain by −3.0 ± 2.8 numeric rating scale, p = 0.012, day 7), while 33% deteriorated. Idiopathic intracranial hypertension patients with mild (numeric rating scale 1–3) or no headache (on the day of lumbar puncture, prior to lumbar puncture) had a high risk of post- lumbar puncture headache exacerbation (81% and 67% respectively). Importantly, there was no relationship between lumbar puncture opening pressure and headache response after lumbar puncture. Conclusion Following lumbar puncture, the majority of idiopathic intracranial hypertension patients experience some improvement, but the benefit is small and post-lumbar puncture headache exacerbation is common, and in some prolonged and severe. Lumbar puncture pressure does not influence the post-lumbar puncture headache.

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2

Porter, Fran L., J. Philip Miller, F. Sessions Cole, and Richard E. Marshall. "A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns." Pediatrics 88, no. 4 (October 1, 1991): 663–69. http://dx.doi.org/10.1542/peds.88.4.663.

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To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.

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3

Pinheiro, Joaquim M. B., Sue Furdon, and Luis F. Ochoa. "Role of Local Anesthesia During Lumbar Puncture in Neonates." Pediatrics 91, no. 2 (February 1, 1993): 379–82. http://dx.doi.org/10.1542/peds.91.2.379.

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Local anesthesia decreases physiologic responses to pain in neonates but has not been used routinely during lumbar punctures in newborns, as it might obscure anatomical landmarks. However, local anesthesia may decrease newborns' struggling during lumbar puncture, thus facilitating the procedure and increasing its success rate. The success rate of lumbar punctures was compared in neonates allocated prospectively to 0.2 to 0.5 mL of 1% lidocaine anesthesia (n = 48) or a control group (n = 52). Newborns were held in a modified lateral recumbent postion (neck not flexed) and their struggling response to the various steps in the lumbar puncture was scored by the holder. The newborns' struggling motion score increased in response to lidocaine injection, but response to the subsequent spinal needle insertion was significantly decreased. Despite this decreased motion, no differences were noted in the number of attempts per lumbar puncture (1.9 ± 0.2 [SEM] in lidocaine and 2.1 ± 0.2 in control groups), rate of lumbar puncture failure (15% in lidocaine and 19% in control groups), or the number of traumatic lumbar punctures (46% in both groups). The success rate of lumbar puncture was not dependent on level of training of physicians performing the procedure. No acute complications, cerebrospinal fluid contamination, or subsequent meningitis was noted in either group. It is concluded that local anesthesia with lidocaine decreases the degree of struggling but does not alter the success rate of lumbar puncture in neonates. The practice of withholding lidocaine anesthesia from neonates undergoing lumbar punctures cannot be justified by arguing that it makes the procedure more difficult to perform.

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4

Farley, Alistair, and Ella McLafferty. "Lumbar puncture." Nursing Standard 22, no. 22 (February 6, 2008): 46–48. http://dx.doi.org/10.7748/ns2008.02.22.22.46.c6358.

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5

Ellenby, Miles S., Ken Tegtmeyer, Susanna Lai, and Dana A. V. Braner. "Lumbar Puncture." New England Journal of Medicine 355, no. 13 (September 28, 2006): e12. http://dx.doi.org/10.1056/nejmvcm054952.

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6

Frizzell, Joan, and Mary Wilby. "Lumbar Puncture." American Journal of Nursing 98, no. 12 (December 1998): 16NN. http://dx.doi.org/10.1097/00000446-199812000-00019.

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7

&NA;. "Lumbar Puncture." AJN, American Journal of Nursing 98, no. 12 (December 1998): 16NN—16PP. http://dx.doi.org/10.1097/00000446-199898120-00011.

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8

PALESTRO, CHRISTOPHER J., SANG 0. LEE, CHUN K. KIM, and STANLEY J. GOLDSMITH. "Lumbar Puncture." Clinical Nuclear Medicine 16, no. 1 (January 1991): 58. http://dx.doi.org/10.1097/00003072-199101000-00017.

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9

Malli, Nisa. "Lumbar Puncture." Anesthesiology 132, no. 6 (June 1, 2020): 1586. http://dx.doi.org/10.1097/aln.0000000000003297.

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10

Gorelick, Philip B., and José Biller. "Lumbar puncture." Postgraduate Medicine 79, no. 8 (June 1986): 257–68. http://dx.doi.org/10.1080/00325481.1986.11699436.

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11

Butson, Ben, and Paul Kwa. "Lumbar puncture." Emergency Medicine Australasia 26, no. 5 (September 3, 2014): 500–501. http://dx.doi.org/10.1111/1742-6723.12290.

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12

Torpy, Janet M., Cassio Lynm, and Richard M. Glass. "Lumbar Puncture." JAMA 296, no. 16 (October 25, 2006): 2050. http://dx.doi.org/10.1001/jama.296.16.2050.

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13

Sternbach, George. "Lumbar puncture." Journal of Emergency Medicine 2, no. 3 (January 1985): 199–203. http://dx.doi.org/10.1016/0736-4679(85)90397-x.

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14

Weerasinghe, Kalani Chisha, Anupama Sharma, Asoka Weerasinghe, and Patrick Tung. "ULTRASOUND ASSISTED LUMBAR PUNCTURE; THE NOT-SO-STEEP LEARNING CURVE." Journal of Neurology, Neurosurgery & Psychiatry 86, no. 11 (October 14, 2015): e4.133-e4. http://dx.doi.org/10.1136/jnnp-2015-312379.43.

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Lumbar puncture is a frequently undertaken procedure in Neurology and Acute Medical settings. It can at times be challenging requiring several attempts causing patient discomfort and anxiety.Ultrasound assisted Lumbar Puncture/Epidurals are currently undertaken by Anaesthetists trained in the technique but not by Neurologists or Medical Physicians in the United Kingdom.Our goal was to train non-Anaesthetic doctors to use ultrasound to assist lumbar punctures through a short training course. The Sonography Assisted Lumbar puncture Training (SALT) course was conducted at Mid Yorkshire Hospitals NHS trust which consisted of 80 minutes of didactic teaching and 160 minutes of supervised scanning.A total of 31 candidates of which 35.48% (n=11) were Neurology trainees and consultants undertook this course. The end of course assessment revealed that 87.09% were able to stabilize the probe and optimize the ultrasound image independently, whereas 93.54% were able to identify the relevant sonoanatomy independently. The remaining candidates demonstrated these skills with minimal prompting.Ultrasound assisted lumbar puncture is a useful technique, which improves the success rate in difficult lumbar punctures. This study shows that it can be taught in a controlled environment through a focussed short training programme.

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15

Halkur Shankar, Sujay, Sagnik Biswas, Arvind Kumar, Akshita Gupta, Aastha Goel, Maroof Ahmad Khan, Rajesh Kumar Singh, Piyush Ranjan, Manish Soneja, and Naveet Wig. "Role of routine use of ultrasonographic guidance for performing lumbar punctures." Postgraduate Medical Journal 97, no. 1143 (December 5, 2019): 23–28. http://dx.doi.org/10.1136/postgradmedj-2019-137058.

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Purpose of studyUltrasound (US) for lumbar puncture has seen the most success in obese patients and in patients with difficult to palpate landmarks. We aimed to elucidate the advantage of the use of routine US for performing lumbar punctures over the traditional landmark method.Study designThis was a prospective study with consecutive sampling with a sample size of convenience. Three residents were chosen to perform the lumbar punctures after a training session. Patients were assigned to either the US group or the landmark group. The outcomes studied were number of attempts at needle insertion, patient and physician anxiety, pain experienced, time to procedure, number of traumatic attempts and the difficulties faced during the procedure.ResultsA total of 77 patients were included in this study, of which 36 patients (46.8%) underwent landmark-based lumbar puncture and 41 (53.2%) underwent US-guided lumbar puncture. There was no statistically significant difference between the two groups among the following characteristics: number of attempts to a successful procedure, number of traumatic punctures, procedure time, preprocedure anxiety of the participants and physicians and pain score rating of the procedure.ConclusionThere was no significant difference between the landmark method and US-guided method for performing lumbar puncture in the number of successful attempts, number of traumatic punctures, procedure time and pain during the procedure. Further studies are required to elucidate the advantage of the use of ultrasonography in subsets of the population such as the low body mass index population.

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16

Evers, S., and T. Ellger. "Intradural Lumbal Hematoma after Lumbar Puncture." Klinische Neurophysiologie 36, no. 2 (June 2005): 98–99. http://dx.doi.org/10.1055/s-2005-866894.

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17

Kreusser, Katherine L., Theodore J. Tarby, Edward Kovnar, Donald A. Taylor, Alan Hill, and Joseph J. Volpe. "Serial Lumbar Punctures for at Least Temporary Amelioration of Neonatal Posthemorrhagic Hydrocephalus." Pediatrics 75, no. 4 (April 1, 1985): 719–24. http://dx.doi.org/10.1542/peds.75.4.719.

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Serial lumbar punctures for the management of neonatal posthemorrhagic hydrocephalus without intracranial hypertension were evaluated in 16 infants. Cranial ultrasonography to evaluate ventricular size and the Ladd monitor at the anterior fontanel to measure intracranial pressure were utilized immediately before and after lumbar puncture. In 12 patients, a decrease in ventricular size and in anterior fontanel pressure could be effected with each lumbar puncture. In these infants, cessation of progression of the hydrocephalus and intermittent decreases in ventricular size were accomplished. In four patients, lumbar punctures were not successful in decreasing ventricular size or lowering intracranial pressure. Two criteria could be defined to determine whether lumbar puncture could provide at least temporary benefit for the treatment of posthemorrhagic hydrocephalus. The first of these is to establish the presence of communication between lateral ventricles and lumbar subarachnoid space by effecting a decrease in ventricular size and a decrease in intracranial pressure by removal of CSF. The second criterion is to ascertain a critical volume of CSF (usually relatively large) that must be removed in order to effect the above changes. Cranial ultrasonography and measurement of intracranial pressure by application of the Ladd monitor to the anterior fontanel are extremely valuable in the evaluation of lumbar punctures in the management of posthemorrhagic hydrocephalus.

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18

Xu, Qian, Xuejun Gao, Qiaohong Zhang, Lei Zang, and Nicholson Maree. "The Mechanism and Therapeutic Effect of Lumbar Intervertebral Disc Foramen Puncture on Neuropathic Pain Based on Digital Medical Technology." Journal of Medical Imaging and Health Informatics 10, no. 8 (August 1, 2020): 1974–80. http://dx.doi.org/10.1166/jmihi.2020.3113.

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Lumbar disc herniation is a relatively common disease in orthopedics, most patients will experience varying degrees of waist pain after suffering from this disease, and severe cases may even be paralysed. In recent years, with the rapid progress of science and technology, minimally invasive surgery technology is also developing rapidly, and its advantages are also very prominent. Puncture technology, as one of the most important and difficult points, has a high requirement for doctors, so it is particularly important to master this technology thoroughly. In order to apply this technique more in clinical practice, improve its accuracy and success rate, and increase the efficiency of operation, 40 patients with lumbar intervertebral disc herniation were selected and randomly divided into experimental group (20 cases) and control group (20 cases). According to the principle of lumbar intervertebral space puncture, its length and angle were adjusted with high precision. Percutaneous lumbar intervertebral foramen puncture locator was used for treatment in the experimental group and the control group was treated with routine nursing intervertebral foramen puncture. The number of punctures, the time needed for successful puncture, the number of successful projections, puncture complications, and clinical efficacy of the two puncture methods were analyzed. The results showed that in the analysis of clinical puncture indicators, the number of punctures, the time needed for puncture, and fluoroscopy times in the experimental group were significantly different from those in the control group (P < 0.01). The puncture method was determined through the design of the surgical approach to alleviate the symptoms as much as possible after operation. In the visual analogue score, follow-up showed that the visual analogue score of the experimental group was significantly lower than that of the previous one month and the last follow-up, with statistical significance (P < 0.01), and the excellent and good rate was significantly increased by using lumbar intervertebral disc puncture, which was 94.7%. Therefore, through this study, it is found that the new type of lumbar intervertebral perforation positioning designed in this study can significantly improve the accuracy of puncture, the success rate increased significantly, and the experiment achieved the desired results. Although there are some shortcomings in the experiment, it still provides experimental basis for the clinical application of lumbar intervertebral disc puncture in the later stage.

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19

Debnam, J. M., D. Schellingerhout, A. J. Kumar, L. Ketonen, K. Shah, L. M. Hamberg, and G. J. Hunter. "Multidetector CT-Guided Lumbar Puncture in Patients with Cancer." Interventional Neuroradiology 15, no. 1 (March 2009): 61–66. http://dx.doi.org/10.1177/159101990901500109.

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Lumbar puncture can be performed for therapeutic purposes, to instill intrathecal chemotherapy for leptomeningeal cancer treatment or prophylaxis. This technique is generally performed blindly or under fluoroscopic guidance. However, in certain situations, lumbar puncture using multidetector CT (MDCT)-guided imaging may be beneficial, when other options have been exhausted or depending on the requirements of the performing radiologist's institution. The purpose of this article is to describe the technique and to evaluate outcomes of MDCT-guided lumber puncture for diagnostic and therapeutic purposes in patients with cancer. We conclude that MDCT-guided lumbar puncture is an effective and safe guiding modality for thecal sac access in patients with cancer, particularly where other methods of intrathecal access have failed.

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20

PORTER, FRAN, J. PHILIP MILLER, F. SESSIONS COLE, and RICHARD E. MARSHALL. "Position for Lumbar Punctures." Pediatrics 89, no. 5 (May 1, 1992): 976. http://dx.doi.org/10.1542/peds.89.5.976a.

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in Reply.— Dr Pinheiro correctly points out that alternative positions for performance of lumbar punctures in newborns have been shown to result in less physiologic perturbation than the position for lumbar puncture used in our study. Although we did not select specifically to study the fully flexed lateral position, it was the most common position for lumbar punctures in our Neonatal Intensive Care Unit at the time our study was conducted.

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21

Millichap, J. Gordon. "Nontraumatic Lumbar Puncture." Pediatric Neurology Briefs 2, no. 9 (September 1, 1988): 69. http://dx.doi.org/10.15844/pedneurbriefs-2-9-7.

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22

Flower, M. "068 Lumbar puncture." Journal of Neurology, Neurosurgery & Psychiatry 83, no. 3 (February 9, 2012): e1.14-e1. http://dx.doi.org/10.1136/jnnp-2011-301993.110.

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23

Hobson, Claire A., Guillaume Desoubeaux, Claudia Carvalho-Schneider, Christophe Destrieux, Jean-Philippe Cottier, Denis Garot, Cécile Le Brun, et al. "Challenging diagnosis of chronic cerebral fungal infection: Value of (1→3)-ß-D-glucan and mannan antigen testing in cerebrospinal fluid and of cerebral ventricle puncture." Medical Mycology 59, no. 1 (May 29, 2020): 74–80. http://dx.doi.org/10.1093/mmy/myaa035.

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Abstract Primary fungal infection of the central nervous system (CNS) is rare but often associated with severe prognosis. Diagnosis is complicated since cerebrospinal fluid (CSF) samples obtained from lumbar puncture usually remain sterile. Testing for fungal antigens in CSF could be a complementary diagnostic tool. We conducted such measurements in CSF from patients with CNS fungal infection and now discuss the usefulness of ventricular puncture. Mannan and (1→3)ß-D-glucan (BDG) testing were retrospectively performed in CSF samples from three patients with proven chronic CNS fungal infection (excluding Cryptococcus), and subsequently compared to 16 controls. Results from lumbar punctures and those from cerebral ventricles were confronted. BDG detection was positive in all the CSF samples (from lumbar and/or ventricular puncture) from the three confirmed cases. In case of Candida infection, mannan antigen measurement was positive in 75% of the CSF samples. In the control group, all antigen detections were negative (n = 15), except for one false positive. Faced with suspected chronic CNS fungal infection, measurement of BDG levels appears to be a complementary diagnostic tool to circumvent the limitations of mycological cultures from lumbar punctures. In the event of negative results, more invasive procedures should be considered, such as ventricular puncture.

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24

Samreen, Sana, Mahnaz Hakeem, Hafsa Zaheer, Ambreen Raza, and Abdul Gaffar Billoo. "Factors Associated with Parental Refusal for Lumber Puncture Among Children and Adolescent: A Cross Sectional Survey at a Tertiary Care Hospital." Pakistan Journal of Medical & Health Sciences 16, no. 10 (October 30, 2022): 442–44. http://dx.doi.org/10.53350/pjmhs221610442.

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Introduction: The lumbar puncture is frequently used in medical facilities to collect data on the cerebrospinal fluid (CSF). The method aids in the diagnosis of conditions affecting the spine and brain's central nervous system. However, in routine practice out of the many challenges posed by the parents due to lack of education, denial of consent for this procedure is a great challenge at clinical settings. Objectives: To determine the association of various factors with parental refusal for lumbar puncture among pediatric population (age from 1 moth to 18 years). Materials and Methods: A descriptive, cross-sectional study was carried out at the department of pediatrics and child health and department of Emergency at Aga Khan University Hospital, Karachi from June 2017 to May 2018. A total of 178 children 1 month to 18 years old admitted with febrile fits, suspected meningitis or encephalitis who were advised for lumber puncture were included. Results: In the present study, the age of the patients ranged from 1 month to 18 year. Majority of the patients 153 (85.39%) were between 1 month to 6 years of age. There were 115 (64.61%) male patients.. Fever and fits was the most frequent indication (n=151, 84.83%) for lumber puncture in the study. Most of the parents were educated, 68.54% of mothers and 65.17% fathers had graduate level of education, and parents of 47 (26.4%) patients refused for lumber puncture. Conclusion: This study concluded that frequency of parental refusal for lumbar puncture was 26.4% and the most common reason for refusal was fear of complications. Keywords: lumbar puncture, febrile seizures, parental refusal.

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25

Sladky, John H., and Stephen E. Piwinski. "Lumbar Puncture Technique and Lumbar Drains." Atlas of the Oral and Maxillofacial Surgery Clinics 23, no. 2 (September 2015): 169–76. http://dx.doi.org/10.1016/j.cxom.2015.05.005.

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Göbel, Hartmut, Horst Klostermann, Volker Lindner, and Sabine Schenkl. "Changes in Cerebral Haemodynamics in Cases of Post-Lumbar Puncture Headache: A Prospective Transcranial Doppler Ultrasound Study." Cephalalgia 10, no. 3 (June 1990): 117–22. http://dx.doi.org/10.1046/j.1468-2982.1990.1003117.x.

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We used transcranial Doppler ultrasonography in 45 patients to investigate if changes in haemodynamics in the major arteries of the brain base occurred after lumbar puncture and whether or not patients with or without post-lumbar puncture headache differ with respect to their cerebral haemodynamic parameters before and after lumbar puncture. Before lumbar puncture, patients with post-lumbar puncture headache differed from patients without post-lumbar puncture headache in that they showed significantly higher flow velocities and significant asymmetry of flow velocities with lateralization to the right ( p £ 0.05). Patients without post-lumbar puncture headache, on the other hand, showed non-significant flow velocity lateralization to the left. Forty-eight hours after lumbar puncture, both groups demonstrated symmetrical flow velocities. In addition, only patients with post-lumbar puncture headache showed a significant reduction in the flow velocity of the right middle cerebral artery ( p £ 0.05). These findings suggest that it is not only absolute flow velocity that plays a part in the event of headache, the interhemispheric relation of cerebral haemodynamics also plays a fundamental role.

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27

Younggren, Bradley N. "Lumbar Puncture and Post-Dural Puncture Headaches." Journal of Emergency Medicine 39, no. 5 (November 2010): 658–59. http://dx.doi.org/10.1016/j.jemermed.2008.12.018.

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28

Vieira, Marcelo Adriano da Cunha Silva, Maria do Amparo Salmito Cavalcanti, Dorcas Lamounier Costa, Kelsen Dantas Eulálio, Otoni Cardoso do Vale, Chrystiany Placido de Brito Vieira, and Carlos Henrique Nery Costa. "Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis." Arquivos de Neuro-Psiquiatria 73, no. 4 (April 2015): 309–13. http://dx.doi.org/10.1590/0004-282x20150002.

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Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP) in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001). The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis.

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Isam Eldin HA Magid, Ibrahim Ali Adlan, Omer Saeed Magzoub, and Omer Ahmed Mohamed Adlan. "Laboratory finding of CSF analysis in patients with meningitis at Elamin Hamid Pediatrics Hospital in Khartoum, Sudan." World Journal of Advanced Research and Reviews 12, no. 3 (December 30, 2021): 550–55. http://dx.doi.org/10.30574/wjarr.2021.12.3.0732.

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Bacterial meningitis in infants and children is a serious clinical entity with signs and symptoms that commonly do not allow distinguishing the diagnosis and the causative agents. The only method to determine if meningitis is the cause of these symptoms is a lumbar puncture. Lumbar puncture is the gold standard for the diagnosis and should be done in all suspected cases of meningitis unless contraindicated. Objectives: The purpose of this study is to identify the importance of the microbiological study of cerebrospinal fluid (CSF) in patients suspected to have acute meningitis. Despite the availability of all other investigations and Imaging for diagnosis of meningitis but CSF analysis remains the most available, accurate, and cheaper for diagnosis of meningitis in children. Methodology and result: This is a prospective study. 71 patients were included. All patients were clinically suspected to have acute meningitis. A lumbar puncture for CSF analysis was done for all patients. The data was collected and analysed. CSF culture was done. The culture was negative In 58 patients (81.7%) and positive in 13 patients (18.3%). Streptococcus was found in 3 patients (4.2 %), staphylococcus epidermidis in 2 patients (2.8%), E Coli in 2 patients (2.8%), klebsiella in 2 patients (2.8%), pneumococci in 2 patient (2.8%), salmonella in 1 patient (1,4%) and Bacilli in 1 patient (1.4 %). Recommendation: Lumbar Puncture (LP) remains the easiest, cheapest and accurate investigation for diagnosis of meningitis in children mainly in rural areas in Sudan and other developing countries. It’s mandatory to offer training for doctors and medical staff for doing lumber punctures safely and accurately and to offer well-equipped laboratories for such essential investigations. It’s not only the role of doctors and medical staff but is a governmental obligation as well. This can save a lot of sick children and prevent mortality and morbidity of acute meningitis in children.

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Silberstein, Stephen D., and James J. Corbett. "The Forgotten Lumbar Puncture." Cephalalgia 13, no. 3 (June 1993): 212–13. http://dx.doi.org/10.1046/j.1468-2982.1993.1303212.x.

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Lumbar puncture is crucial in two distinct clinical situations in the diagnosis of the headache patient. The first is the patient who is suspected of having a symptomatic headache; the second is the patient with a chronic intractable or atypical headache disorder. This review discusses the usefulness of the lumbar puncture in the diagnosis of headache secondary to subarachnoid hemorrhage, meningitis, and intracranial hypotension and hypertension. The value of lumbar puncture in the presence of a normal CT/MRI scan is discussed.

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31

Cauley, Keith A. "Fluoroscopically Guided Lumbar Puncture." American Journal of Roentgenology 205, no. 4 (October 2015): W442—W450. http://dx.doi.org/10.2214/ajr.14.14028.

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32

Concescu, D., I. Moldovanu, S. Odobescu, J. Mawet, A. Ruseva, V. Vovc, and C. Roos. "Post-lumbar puncture syndrome." Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova 118, no. 11 (2018): 87. http://dx.doi.org/10.17116/jnevro201811811187.

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33

Boyer, Kenneth M., and Samuel P. Gotoff. "Lumbar Puncture in Meningitis?" Pediatrics 98, no. 1 (July 1, 1996): 166. http://dx.doi.org/10.1542/peds.98.1.166.

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Wiswell et al1 assert that "if lumbar punctures (LPs) are omitted as part of the early neonatal sepsis evaluation, the diagnosis of bacterial meningitis occasionally will be delayed or missed completely." They call into question a study from our institution as well as several others2-5 that have recently concluded that cerebrospinal fluid (CSF) examination is not indicated in asymptomatic neonates with antepartum risk factors for infection." We would like to raise for discussion the semantics of Dr Wiswell's assertion and the data upon which it is based.

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34

Silberstein, Peter. "Lumbar puncture in meningitis." Medical Journal of Australia 144, no. 2 (January 1986): 110–11. http://dx.doi.org/10.5694/j.1326-5377.1986.tb113682.x.

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35

FORESTER, DONALD. "Contraindications to Lumbar Puncture." Annals of Internal Medicine 105, no. 5 (November 1, 1986): 805. http://dx.doi.org/10.7326/0003-4819-105-5-805_1.

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36

McGRUDER, JON M., JAMES E. COOKE, JOANNE M. CONROY, and J. DAVID BAKER. "Headache After Lumbar Puncture." Southern Medical Journal 81, no. 10 (October 1988): 1249–52. http://dx.doi.org/10.1097/00007611-198810000-00012.

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37

RUSHING, JILL. "Assisting with lumbar puncture." Nursing 37, no. 1 (January 2007): 23. http://dx.doi.org/10.1097/00152193-200701000-00015.

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38

Harrop-Griffiths, William. "Technique of lumbar puncture." Anaesthesia & Intensive Care Medicine 5, no. 5 (May 2004): 154. http://dx.doi.org/10.1383/anes.5.5.154.33999.

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39

Vilming, ST, and R. Kloster. "Post-Lumbar Puncture Headache." Cephalalgia 17, no. 7 (November 1997): 778–84. http://dx.doi.org/10.1046/j.1468-2982.1997.1707778.x.

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Abstract:

The aim of the present prospective study was to describe clinical features of post-lumbar puncture headache (PPH), and to test the validity of the diagnostic criteria of the International Headache Society (IHS). Eighty-eight of the 239 included patients (36.8%) experienced PPH. Females were affected more frequently than males (45.2% vs 21.4%; p<0.001) First onset of PPH occurred within the first day in 40 patients (53%), within 2 days in 89%, and never after the fourth day. When PPH occurred for the first time on the day the lumbar puncture was performed, it was usually experienced much later in the day (median 14.00 h) than it first occurred on the second day (median 09.30 h) or later. The median duration of PPH was 6 days (range 1–29 days). Patients with headache performed a “Rising Manoeuvre” twice daily as long as the headache period lasted, and recorded pair and time variables. The severity of PPH was negatively correlated to the time till the headache started or worsened upon rising (T1 and the time from the headache started to increase till it reached its maximum (T2) but was not significantly correlated to the time to restitution upon lying down (T3). The results are in good accordance with the leakage theory. T1 varied from immediate onset to 265 min (median 20 sec). T2 (median 30 sec, range 0–60 min) and T3 (median 20 sec, range 0–15 min) varied considerably as well. During the course of PPH, 45% of the patients occasionally reported non-postural headache or no headache when the Rising Manoeuvre was performed. It is suggested that PPH should be diagnosed in any patient who experiences postural headache at least once within 4 days of lumbar puncture.

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Bousser, MG. "Post-Lumbar Puncture Headache." Cephalalgia 18, no. 3 (April 1998): 162. http://dx.doi.org/10.1046/j.1468-2982.1998.1803162.x.

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Silberstein, SD. "Post-lumbar puncture headache." Cephalalgia 18, no. 9 (November 1998): 591. http://dx.doi.org/10.1046/j.1468-2982.1998.1809591-2.x.

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Muldoon, T., S. Yentis, F. Reynolds, G. O'Sullivan, A. Strachan, J. Train, M. R. Nel, and N. Robinson. "Lumbar puncture and headache." BMJ 316, no. 7136 (March 28, 1998): 1018. http://dx.doi.org/10.1136/bmj.316.7136.1018.

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Frederiks, J. A. M., and P. J. Koehler. "The first lumbar puncture*." Journal of the History of the Neurosciences 6, no. 2 (August 1997): 147–53. http://dx.doi.org/10.1080/09647049709525699.

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44

Andériz, Francisco Ortuño, Antonio Blesa Malpica, Eduardo Morales Sorribas, Noemí Cabello Clotet, and Josué Avecillas Chasin. "Paraplegia After Lumbar Puncture." American Journal of the Medical Sciences 347, no. 2 (February 2014): 170–71. http://dx.doi.org/10.1097/maj.0000000000000218.

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Evans, Randolph W. "COMPLICATIONS OF LUMBAR PUNCTURE." Neurologic Clinics 16, no. 1 (February 1998): 83–105. http://dx.doi.org/10.1016/s0733-8619(05)70368-6.

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46

Frizzell, Joan, and Mary Wilby. "Diagnostic Tests: Lumbar Puncture." American Journal of Nursing 98, no. 12 (December 1998): 16NN. http://dx.doi.org/10.2307/3471707.

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Arendt, Katherine, Bart M. Demaerschalk, Dean M. Wingerchuk, and William Camann. "Atraumatic Lumbar Puncture Needles." Neurologist 15, no. 1 (January 2009): 17–20. http://dx.doi.org/10.1097/nrl.0b013e318184f476.

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Sahebkar-Moghaddam, F., and B. T. Adornato. "The failed lumbar puncture." Neurology 64, no. 7 (April 11, 2005): E24. http://dx.doi.org/10.1212/01.wnl.0000164849.90985.2f.

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Richards, P. G., and E. Towu-Aghantse. "Dangers of lumbar puncture." BMJ 292, no. 6520 (March 1, 1986): 605–6. http://dx.doi.org/10.1136/bmj.292.6520.605.

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Dezateux, C., R. Dinwiddie, and D. J. Matthew. "Dangers of lumbar puncture." BMJ 292, no. 6523 (March 22, 1986): 827–28. http://dx.doi.org/10.1136/bmj.292.6523.827-b.

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