Transtentorial Herniation after Lumbar Puncture in a Patient with Clinical Suspicion of Increased Intracranial Pressure

Abstract Background Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial pressure without a clear cause and can have serious visual effects. Previous research work suggests that transcranial Doppler measurements of pulsatility index correlate accurately with elevated intracranial pressure. Objective To assess the cerebrovascular hemodynamic changes in patients with IIH using transcranial Doppler before and after lumbar puncture and CSF withdrawal. Methods An interventional study conducted on 40 patients (31 females and 9 males) fulfilling the modified Dandy criteria for diagnosis of idiopathic intracranial hypertension, MRI brain, and MRV was done to the patients. Lumbar puncture was done for all included patients to measure intracranial pressure and CSF withdrawal. Transcranial Doppler was performed for all included before and after lumbar puncture and CSF withdrawal and the following parameters were measured: peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsatility index (PI). Results Significant relation was found between grades of papilledema and PSV, RI, and PI (p value 0.012, 0.025, 0.016) but no significant relation was found between grades of papilledema and EDV (0.102). Significant changes occurred in parameters of TCD pre- and post-CSF withdrawal including PSV, EDV, and PI (p value 0.001, 0.015, 0.019) denoting a significant change in cerebral hemodynamics after CSF withdrawal which denotes a decrease in intracranial pressure. Conclusion Increased intracranial pressure significantly affects cerebral blood flow. A normalization of transcranial Doppler parameters occurs following lowering of intracranial pressure through lumbar puncture and CSF withdrawal.

Download Full-text

Lumbar Puncture Opening Pressure in Patients with Spinal Muscular Atrophy

Neuropediatrics ◽

10.1055/s-0040-1722687 ◽

2021 ◽

Author(s):

Lena-Luise Becker ◽

Claudia Weiß ◽

Anna Tietze ◽

Viktoria Martiny ◽

Angela M. Kaindl

Keyword(s):

Intracranial Pressure ◽

Spinal Muscular Atrophy ◽

Lumbar Puncture ◽

Clinical Data ◽

Side Effect ◽

Treatment Initiation ◽

Muscular Atrophy ◽

Underlying Disease ◽

Increased Intracranial Pressure ◽

Opening Pressure

AbstractThe announcement of a hydrocephalus as a possible side effect in patients with spinal muscular atrophy (SMA) receiving the drug nusinersen, promoted major concern and warrants further evaluation. In this retrospective monocentric study, we analyzed clinical data, lumbar puncture opening pressure (LOP) measurement, and ophthalmologic and neuroimaging results in 34 patients with SMA types 1 to 3 undergoing treatment with nusinersen. None of the patients reported symptoms indicative of increased intracranial pressure. In our cohort, the LOP was >20 cm H2O in 25 patients (70.5%), and within this group ≥28 cm H2O in 12 patients (35.3%), in two patients, it was increased prior to treatment initiation. Signs of increased intracranial pressure in ophthalmological assessments or brain imaging were only seen in one patient. We did not identify a correlation between increased LOP and SMA type, scoliosis, or age of the patients; however, it was slightly higher in patients receiving sedation. Our results raise the question whether the LOP is generally increased in SMA as part of the underlying disease, if so, what the etiology is, and whether the increased LOP needs to be treated.

Download Full-text

DANGERS OF DIAGNOSTIC LUMBAR PUNCTURE IN INCREASED INTRACRANIAL PRESSURE DUE TO TUMOR OF THE BRAIN

Archives of Neurology And Psychiatry ◽

10.1001/archneurpsyc.1929.02210230155010 ◽

1929 ◽

Vol 21 (5) ◽

pp. 1141 ◽

Cited By ~ 1

Author(s):

CLEMENT B. MASSON

Keyword(s):

Intracranial Pressure ◽

Lumbar Puncture ◽

Increased Intracranial Pressure ◽

Diagnostic Lumbar Puncture ◽

The Brain

Download Full-text

Isolated intracranial hypertension following COVID-19 vaccination: A case report

Cephalalgia Reports ◽

10.1177/25158163211044797 ◽

2021 ◽

Vol 4 ◽

pp. 251581632110447

Author(s):

Dennis C Thunstedt ◽

Andreas Straube ◽

Florian Schöberl

Keyword(s):

Intracranial Pressure ◽

Chronic Headache ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Clinical Suspicion ◽

Temporal Association ◽

Pathological Findings ◽

Increased Intracranial Pressure ◽

Venous Sinus Thrombosis ◽

New Onset

Increased intracranial pressure in cerebral venous sinus thrombosis or metabolic disease has been reported. We present a case of new-onset chronic headache and bilateral papilledema in the setting of elevated intracranial pressure in strong temporal association to vaccination against COVID-19 with AstraZeneca. After repeated drainage of cerebrospinal fluid and conservative drug therapy, pathological findings were regredient. Even in absence of typical risk factors, increased intracranial pressure should be considered in case of clinical suspicion after COVID-19 vaccination.

Download Full-text