Dynamic Studies on the Cerebrospinal Fluid in the Differential Diagnosis of Lateral Sinus Thrombosis

The rise and fall of Queckenstedt's test between 1916 and 1970, a milestone in spinal cord diagnostics and why it matters

“…Several studies advanced the value of Queckenstedt's test through refinement and advanced recording methods. We propose a top 10 reading list of the historical literature on Queckenstedt's test [ 1 , 5 , 9 , 10 , 12 , 16 , 20 , 22 , 24 , 27 ].…”

“…There, together with George L. Tobey (1881Tobey ( -1967, he used Queckenstedt's test for the diagnosis of lateral sinus thrombosis. In their initial description of seven cases, they applied bilateral or unilateral jugular vein compression during lumbar puncture [12]. In 1925, it was found that unilateral compression on the affected side would not lead to as high a rise in CSF pressure on the healthy side; this became the "Tobey-Ayer" test.…”

Lateral Sinus Thrombosis Complicating Masked Mastoiditis

“…This test was described by Dowman,17 Tobey and Ayer, 18 Bruenings 1!l and Perwizschky.20 All of these investigators arrived at the same conclusions independently of one another. A test for determining sinus throm¬ bosis based on changes in the spinal fluid pressure is of value in the diagnosis.…”

Collecting Cerebrospinal Fluid

“…There should be a rapid rise of the cerebrospinal fluid pressure to 10-30 cm above baseline. Manual compression of the jugular vein on only one side (the Tobey-Ayer test) should produce only a slight change in cerebrospinal fluid pressure unless there is obstruction of one of the lateral venous sinuses, such as by sinus thrombo-phlebitis [76]. Unfortunately, variability in the normal venous drainage of the brain (usually the right lateral sinus is much larger than the left lateral sinus) may make this test unreliable.…”