Brain Tumor and Lumbar Puncture

Abstract

A NUMBER of observers have reported untoward reactions following lumbar puncture in patients with tumors of the brain or with increased intracranial pressure due to other causes.* These untoward reactions have been attributed to temporal lobe herniation or herniation of the cerebellar tonsils. In some of the cases death is reported to have occurred immediately from presumed compression of vital centers, and in others a train of symptoms have developed which are presumed to indicate a more gradual compression.The statement is frequently seen that lumbar puncture is dangerous and is contraindicated whenever papilledema is present. This conclusion is reached on the basis of untoward reactions in individual cases, and to our knowledge there has not been an analysis of the results in a large series of cases. This study was undertaken in order to determine the frequency of untoward reactions in a large series of patients with tumors of the brain on whom a lumbar puncture was performed. MATERIALAll of the available brain tumor cases (965) at the Neurological Institute of New York, from January, 194S, to July, 1953, were reviewed ; only those patients who had lumbar puncture performed prior to arteriography, air studies, or surgery were included. A total of 401 histologically verified cases were available for this study, with the exception of 15 brain stem neo¬ plasms that were verified by surgery or air studies.For this survey, the status of all the patients was carefully evaluated from the time of the lumbar puncture until arteriography, air studies, or surgery. A careful search was made for the presence of symptoms or signs indicating an adverse effect of the lumbar puncture, with special attention to signs of temporal lobe herniation or herniation of the cerebellar tonsils. Particular attention was given to the following : third nerve involvement as evidenced by pupillary dilatation or extraocular muscle paralysis ; changes of the blood pressure, pulse, respirations, and tempera¬ ture; the appearance of convulsions; decerebrate rigidity; changes in the state of consciousness, and unexpected progression in neurologic deficit. RESULTSDivision of the cases according to the anatomical location and histologie type is shown in Table 1. There were 164 tumors in the anterior fossa, 140 in the middle fossa, 74 in the posterior fossa, 10 in the sellar and parasellar region, and 13 multiple metastatic lesions. The general histologie distribution of these cases followed that reported in other large series of cases of brain tumors.From the Neurological Institute of the Presbyterian Hospital, New York.References 1 through 5. Downloaded From: http://archneurpsyc.jamanetwork.com/ by a Karolinska Institutet University Library User on 05/25/2015

Cranial Computed Tomography Before Lumbar Puncture

“…2 Subsequently, numerous case reports and case series attempted to identify the patients at the highest risk for complications. [3][4][5][6] The advent of computed tomography (CT) of the brain gave hope that all potentially lifethreatening complications of LP could be prevented.…”

Absence of papilloedema in cerebral tumors.

“…However, there is a high (though not absolute) correlation between papilloedema and CSF pres-sure in cerebral tumours, known from the literature on lumbar puncture (Lubic and Marotta, 1954;Korein et al, 1959;van der Lugt and Molin, 1968), from continuous recording of ventricular fluid pressure in cerebral tumours (Lundberg, 1960), and confirmed for cisternal fluid pressure in experimental space-occupying lesions (Hayreh, 1968). Accordingly, in the present series the CSF pressure was normal or only slightly raised in seven of the eight cases where it was measured.…”

Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: A Review

“…Schaller's series of 49 cases with papilledema were "unselected cases of lumbar puncture in cases of intracranial pressure or in cases of suspected intracranial pressure" [22]. Lubic and Marotta's [23] series of 46 cases with papilledema were from a population of 965 patients with brain tumors of whom 401 had an LP, and only 32 had a documented high ICP. Masson's series, quoted as having 144 cases of brain tumor with papilledema, had only 94 cases with proven brain tumor [24].…”