Fine-needle, negative-pressure lumbar puncture: A safe technique for collecting CSF

Linker, Gary; Mirza, Nadeem Q.; Manetti, G.; Meyer, Mark J.; Putnam, Karen; Sunderland, Tom

doi:10.1212/01.wnl.0000038360.01635.39

Cited by 16 publications

(25 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This approach is consistent with the AAN guidelines [3,4] stating that "smaller needle size is associated with reduced frequency of PDPH", it is supported by extensive anesthesiologic literature [10,22] and by 2 research studies in Alzheimer and control subjects [12,13] performed with 25W [12] and 24S needles [13] and reporting 4% and 0.93% of PDPH respectively. The use of small needles during diagnostic LP contrasts with the traditional neurological practice and encounters the reluctance of neurologists grounded on a long list of concerns: higher cost, greater difficulty, slow flow of CSF requiring aspiration with negative pressure, longer time of the procedure and lower patients' safety.…”

Section: Discussionsupporting

confidence: 80%

“…Aspiration of CSF through a syringe during LP seems to be a dangerous procedure that increases the risk of brain herniation, however the data collected in this study and in previous ones [12,13] The risk of damage to nerve root filaments caused by aspiration through the tip of the needle was also ruled out, as the pain referred by patients was similar with all the needles (Tab. 1).…”

Section: Q and 22s (Tab 1)mentioning

confidence: 72%

“…[7,8,9] The risk of PDPH is substantially reduced by the use of smaller, 24G-26G, non-cutting needles, a long-standing standard procedure among anaesthesiologists [10]. Although anesthesiologists must inject anesthetics and neurologists must aspirate CSF the same small type of needles could be used as suggested by 3 neurological studies using 24-26G needles: a randomized double-blind clinical trial in normal individuals [11] and two studies in Alzheimer and control subjects [12,13]. The percentage of PDPH in those studies was 12%, 4%, and 0.93 % respectively.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The use of the 25 Sprotte needle markedly reduces post-dural puncture headache in routine neurological practice

Bertolotto¹,

Malentacchi²,

Capobianco³

et al. 2015

Cephalalgia

View full text Add to dashboard Cite

Objectives: to test the feasibility of lumbar puncture (LP) using 25 gauge (G) needles in daily neurological practice and to compare the risk of post-dural puncture headache (PDPH) with 4 types of needles. Methods:In a prospective rater-blind study, pros and cons of 4 different LP needles, 20G Quincke (20Q), 22G Sprotte (22S), 25G Whitacre (25W), and 25G Sprotte (25S), were evaluated in 394 LPs performed by 7 neurologists. The neurologist performing the LP recorded type and size of needle, intensity of pain, safety, time of the procedure and failure or success.Between 5 and 15 days later another neurologist, blind for the type of needle used, completed an ad-hoc questionnaire for PDPH.Results: PDPH developed in 35.9% patients when using a 20Q needle, in 12.9%, 6.8% and 1.6% respectively when using a 22S, 25W or 25S needle. The difference in incidence of PDPH following LP performed with 20Q needle and 25S or 22S was statistically significant (p<0.001 and p=0.008 respectively) and it approached significance when comparing 25S and 25W (p=0.06). As 25W and 25S needles need CSF aspiration LP requires more time and skill. Pain caused by LP was similar with the 4 needles. Conclusion:The use of 25S needle in diagnostic LP reduces the frequency and severity of PDPH.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Q and 22s (Tab 1)mentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The use of the 25 Sprotte needle markedly reduces post-dural puncture headache in routine neurological practice

Bertolotto¹,

Malentacchi²,

Capobianco³

et al. 2015

Cephalalgia

View full text Add to dashboard Cite

show abstract

“…While lifethreatening adverse events from LPs are rare, the prevalence of postlumbar puncture headaches (PLPHs) ranges between 1 and 36% depending on needle type and patient population [1][2][3]. PLPHs range from mild to debilitating and are defined by their positional nature in that patients experience some relief in the supine position and worsening in the upright position.…”

Section: Introductionmentioning

confidence: 99%

Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic

Hammond

Wang

Bhulani

et al. 2011

Journal of the Neurological Sciences

View full text Add to dashboard Cite

“…In the hands of a trained clinician using proper techniques and equipment, LP is less unpleasant than many other procedures patients undergo on a yearly basis, including pelvic exams, digital rectal exams, and mammograms. It carries a very low risk of adverse events, even for patients with AD [2,4,5]. Indeed, the American Academy of Neurology, in recently published guidelines on post-LP headache [1], concluded that use of small gauge atraumatic spinal needles very substantially reduces risk of post-LP headache and calls for the development of standardized educational materials to train clinicians in these techniques.…”

mentioning

confidence: 99%

Biomarkers for Alzheimer's disease

Peskind¹,

Montine²

2006

JAD

View full text Add to dashboard Cite

The data that define the state of biological markers (biomarkers) for Alzheimer's disease (AD) are reviewed in the articles that follow along with a summary of clinical examination, the gold standard to which any successful biomarker will be compared. Some biomarkers focus on reflecting events specific to AD, such as amyloid β (Aβ) 42 and phospho-tau, while other biomarkers are directed at assessing pathogenic processes that occur in AD as well as other diseases of brain. As will be discussed in the coming articles, both have important roles to serve. AD-specific biomarkers clearly are needed for the differential diagnosis of cognitive impairment in the elderly. Process-specific biomarkers, like markers for inflammation of oxidative damage, although unlikely on their own to be sufficiently discriminating of AD vs. other diseases of brain, will be very useful in determining pharmacologic responses to therapeutics in patients already identified by clinical exam, neuroimaging, and disease-specific biomarkers to be in the early stages of AD. Here we wish to convey the critical need to discover and develop biomarkers for AD and the impact this will have on improving the diagnosis and management of dementia.AD and related dementias are degenerative disorders, primarily of the aged. They are not dissimilar from many other age-related disorders for which clinicians diligently screen and monitor, often with expensive tests and procedures. Such clinical activities are done less with the expectation of reversing disease than with the goal of preventing further end-organ damage. However, what sets hypertension, hypercholesterolemia, and diabetes mellitus apart from AD is that each has biomarkers that can be followed easily and repeatedly, not simply to diagnose but also to monitor response and to optimize treatment. In contrast, the current role of clinical laboratory evaluation for dementia is exclusionary. The development of such biomarkers is critical to translating efficiently the new therapeutic approaches for AD under development by many research groups into treatments for the millions who suffer from AD.Advances in neuroimaging also likely will lead to it serving an important role in understanding dementia and its prodrome. Indeed, the Alzheimer's Disease Neuroimaging Initiative, a large collaboration among the National Institute on Aging, several universitybased research groups, and industry, evaluates the utility of both structural and functional brain imaging to follow the progression of early AD and its prodrome. Imaging probes for selected facets of AD also are being developed; for example, in vivo imaging of brain amyloid appears to show promise even in asymptomatic individuals [3]. However, neuroimaging has its own set of scientific, technical, and practical limitations that, in our opinion, limit this approach from becoming more than complementary to biochemical markers of AD. Put another way, the diagnosis and management of diabetes mellitus would be entirely different if it relied principally on structural ...

show abstract

Fine-needle, negative-pressure lumbar puncture: A safe technique for collecting CSF

Cited by 16 publications

References 7 publications

The use of the 25 Sprotte needle markedly reduces post-dural puncture headache in routine neurological practice

The use of the 25 Sprotte needle markedly reduces post-dural puncture headache in routine neurological practice

Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic

Biomarkers for Alzheimer's disease

Contact Info

Product

Resources

About