The risk of abducens palsy after diagnostic lumbar puncture

Abstract The effect of traumatic lumbar puncture at the time of initial diagnostic workup on treatment outcome in children with newly diagnosed acute lymphoblastic leukemia (ALL) was investigated. The findings of the first 2 lumbar punctures performed on 546 patients with newly diagnosed ALL treated on 2 consecutive front-line studies (1984-1991) at St Jude Children's Research Hospital were retrospectively reviewed. Lumbar punctures were performed at the time of diagnosis and again for the instillation of first intrathecal chemotherapy. The event-free survival (EFS) experience for patients with 1 cerebrospinal fluid (CSF) sample contaminated with blast cells was worse than that for patients with no contaminated CSF samples (P = .026); that of patients with 2 consecutive contaminated CSF samples was particularly poor (5-year EFS = 46 ± 9%). In a Cox multiple regression analysis, the strongest prognostic indicator was 2 consecutive contaminated CSF samples, with a hazard ratio of 2.39 (95% confidence interval, 1.36-4.20). These data indicate that contamination of CSF with circulating leukemic blast cells during diagnostic lumbar puncture can adversely affect the treatment outcome of children with ALL and is an indication to intensify intrathecal therapy.

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Traumatic vs. atraumatic 22 G needle for therapeutic and diagnostic lumbar puncture in the hematologic patient: a prospective clinical trial

Haematologica ◽

10.3324/haematol.10883 ◽

2007 ◽

Vol 92 (7) ◽

pp. 1007-1008 ◽

Cited By ~ 8

Author(s):

R. Lavi ◽

J. M. Rowe ◽

I. Avivi

Keyword(s):

Clinical Trial ◽

Lumbar Puncture ◽

Prospective Clinical Trial ◽

Diagnostic Lumbar Puncture

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Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2018-000412 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000412 ◽

Cited By ~ 4

Author(s):

Abiola Olowoyeye ◽

Opeyemi Fadahunsi ◽

Jerome Okudo ◽

Oluwakare Opaneye ◽

Charles Okwundu

Keyword(s):

Lumbar Puncture ◽

Ultrasound Imaging ◽

Risk Ratio ◽

Ultrasound Guidance ◽

Data Extraction ◽

Meta Analysis ◽

Study Selection ◽

Registration Number ◽

Diagnostic Lumbar Puncture ◽

Neonates And Infants

ImportanceLumbar puncture (LP) failure rates vary and can be as high as 65%. Ultrasound guidance could increase the success of performing LP.ObjectiveTo summarise the evidence on the use of ultrasound guidance versus palpation method for LP.Data sourcesWe searched computerised databases and published indexes, registries and references identified from bibliographies of pertinent articles without any language restrictions to find studies that compared ultrasound guidance to palpation method for performing an LP.Study selectionStudies were included if they were randomised or quasirandomised trials in neonates and infants that compared ultrasound guidance with palpation method for performing an LP.Data extraction and synthesisStandardised data collection tool was used for data extraction, and two reviewers independently assessed the quality of the studiesMain outcome(s) and measure(s)The primary outcome was the risk of LP failure, while the risk of traumatic tap, needle redirections/reinsertions and procedure durations were secondary outcomesResultsData from four studies and 308 participants is included in the analysis. Ultrasound imaging reduced the risk of LP failure, risk ratio of 0.58 (95% CI 0.15 to 2.28), but it was not statistically significant (p=0.44). Ultrasound imaging significantly reduced the risk of a traumatic tap risk ratio of 0.33 (95% CI 0.13 to 0.82) and p=0.02. The included studies had low to moderate quality; the studies differed based on mean age and with variability on outcome definition.Conclusions and relevanceThis meta-analysis suggests that ultrasound imaging has no effect in increasing lumbar success but is beneficial in reducing the risk of traumatic taps in neonates and infants.Trial registration numberCRD42017055800.

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Post-Lumbar Puncture Headache—Does Hydration before Puncture Prevent Headache and Affect Cerebral Blood Flow?

Journal of Clinical Medicine ◽

10.3390/jcm8101710 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1710 ◽

Cited By ~ 1

Author(s):

Magdalena Nowaczewska ◽

Beata Kukulska-Pawluczuk ◽

Henryk Kaźmierczak ◽

Katarzyna Pawlak-Osińska

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Lumbar Puncture ◽

Cerebral Arteries ◽

Mean Velocity ◽

Oral Fluids ◽

Middle Cerebral Arteries ◽

Before And After ◽

Diagnostic Lumbar Puncture ◽

Baseline Values

Headache is a common complication after diagnostic lumbar puncture (DLP). We aimed to check whether hydration before puncture influences the incidence of post-lumbar puncture headache (PLPH) and affects cerebral blood flow. Ninety-nine patients enrolled for puncture were assigned to a group with (n = 40) or without hydration (n = 59). In the hydration group, 1000 mL 0.9% NaCl was infused and a minimum of 1500 mL oral fluids was recommended within the 24 h before puncture. A Transcranial Doppler (TCD) was performed before and after DLP. Mean velocity (Vm) and pulsatility index (PI) were measured in the middle cerebral arteries (MCAs). PLPH occurred in 28 patients (28.2%): six (15.4%) from the hydrated and 22 (37.3%) from the non-hydrated group (p < 0.023). Patients with PLPH were younger (p < 0.014) and with headaches in their histories (p < 0.036) compared with the non-headache group. Vm values in both MCAs after puncture were significantly lower than before puncture in all patients. In the PLPH group, Vm in MCAs before puncture were significantly higher and the PI was lower than in the non-headache group. Our findings suggest that hydration of patients within 24 h before puncture prevented PLPH. Twenty-four hours after puncture, significant decreases in Vm were observed in the MCAs of all patients. Low baseline values of PI and high Vm predisposed patients to PLPH.

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