Spinal Subarachnoid Block as Determined by Combined Cistern and Lumbar Puncture

Ayer, James B.

doi:10.1001/archneurpsyc.1922.02190070041002

Cited by 22 publications

(10 citation statements)

References 2 publications

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“…Improvements in Queckenstedt's test by simultaneous recording from the cisterna magna and lumbar sac were reported, using open-ended manometers, by Ayer (1921). Improvements in Queckenstedt's test by simultaneous recording from the cisterna magna and lumbar sac were reported, using open-ended manometers, by Ayer (1921).…”

mentioning

confidence: 99%

Simultaneous cerebral and spinal fluid pressure recordings

Williams¹

1981

Acta neurochir

161

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Simultaneous intraventricular and intraspinal pressure recordings in erect patients with obstructive lesions of th CSF pathways reveal differences in pressure which are frequently transitory and produced by pulsation. In non-acute cases without papilloedema but with suspected hindbrain hernia delay in equalization after pressure pulses may be demonstrated, and after Valsalva's manoeuvre differences between the head and the spine may be generated transiently and be responsible for clinical symptomatology. The particular clinical features related to hindbrain hernia are syringomyelia, cough headache, cough syncope, and lower cranial nerve signs with oscillopsia and cerebellar ataxia. Correction of the pressure dissociation is often associated with marked clinical improvement. It is suggested that this form of testing may be of relevance as an indication for operation and also for monitoring the progress of post-operative patients.

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confidence: 99%

Simultaneous cerebral and spinal fluid pressure recordings

Williams¹

1981

Acta neurochir

161

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“…The lumbar/cistemal protein ratio was 15:1, but the block was not complete. In these cases the lumbar/cisternal protein ratio is a more reliable early guide (Ayer, 1922).…”

Section: Discusiomentioning

confidence: 99%

“…The presence of a block is more certain if there is a gross difference between the protein content of the lumbar and the cisternal fluid (Ayer, 1922), although it is known that when there is an increase in the C.S.F. protein, that increase is greatest in the lumbar fluid (Merritt and Fremont-Smith, 1937b).…”

mentioning

confidence: 99%

Studies of the Cerebrospinal Fluid Circulation in Tuberculous Meningits in Children: Part I. The Use of Penicillin as a Tracer Substance

Lorber¹

1950

Archives of Disease in Childhood

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“…CSF pressure dynamics (CSFP) communicate between the cranial and spinal CSF compartments under physiological conditions ( 3 ). In presence of cervical spinal canal obstruction, the cranial and spinal pressure compartments become dissociated, and induced elevation of intracranial pressure does not translate to the lumbar level ( 4 ). Manual compression of jugular veins with parallel evaluation of lumbar CSFP (the Queckenstedt's test) was routinely done to determine spinal obstruction with moderate to low test sensitivity before it was replaced by spinal neuroimaging ( 4 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…In presence of cervical spinal canal obstruction, the cranial and spinal pressure compartments become dissociated, and induced elevation of intracranial pressure does not translate to the lumbar level ( 4 ). Manual compression of jugular veins with parallel evaluation of lumbar CSFP (the Queckenstedt's test) was routinely done to determine spinal obstruction with moderate to low test sensitivity before it was replaced by spinal neuroimaging ( 4 – 7 ). However, cervical spinal canal stenosis is highly prevalent on MRI, up to 24% in elderly patients ( 8 ), and not necessarily associated with clinical symptoms ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions

et al. 2022

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Spinal canal narrowing with consecutive spinal cord compression is considered a key mechanism in degenerative cervical myelopathy (DCM). DCM is a common spine condition associated with progressive neurological disability, and timely decompressive surgery is recommended. However, the clinical and radiological diagnostic workup is often ambiguous, challenging confident proactive treatment recommendations. Cerebrospinal fluid pressure dynamics (CSFP) are altered by spinal canal narrowing. Therefore, we aim to explore the potential value of bedside CSFP assessments for qualitative and quantitative assessment of spinal canal narrowing in DCM. In this prospective case series, seven patients with DCM underwent bedside lumbar puncture with measurement of CSFP dynamics and routine CSF analysis (NCT02170155). The patients were enrolled when standard diagnostic algorithms did not permit a clear treatment decision. Measurements include baseline CSFP, cardiac-driven CSFP peak-to-trough amplitude (CSFPp), and the Queckenstedt's test (firm pressure on jugular veins) in neutral and reclined head position. From the Queckenstedt's test, proxies for craniospinal elastance (i.e., relative pulse pressure coefficient; RPPC-Q) were calculated analogously to infusion testing. CSFP metrics were deemed suspicious of canal narrowing when numbers were lower than the minimum value from a previously tested elderly spine-healthy cohort (N = 14). Mean age was 56 ± 13 years (range, 38–75; 2F); symptom severity was mostly mild to moderate (mean mJOA, 13.5 ± 2.6; range, 9–17). All the patients showed some extent of cervical stenosis in the MRI of unclear significance (5/7 following decompressive cervical spine surgery with an adjacent level or residual stenosis). Baseline CSFP was normal except for one patient (range, 4.7–17.4 mmHg). Normal values were found for CSFPp (0.4–1.3 mmHg) and the Queckenstedt's test in normal head positioning (9.-25.3 mmHg). During reclination, the Queckenstedt's test significantly decreased in one, and CSFPp in another case (>50% compared to normal position). RPPC-Q (0.07–0.19) aligned with lower values from spine-healthy (0.10–0.44). Routine CSF examinations showed mild total protein elevation (mean, 522 ± 108 mg/ml) without further evidence for the disturbed blood brain barrier. Intrathecal CSFP measurements allow discerning disturbed from normal CSFP dynamics in this population. Prospective longitudinal studies should further evaluate the diagnostic utility of CSFP assessments in DCM.

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Spinal Subarachnoid Block as Determined by Combined Cistern and Lumbar Puncture

Cited by 22 publications

References 2 publications

Simultaneous cerebral and spinal fluid pressure recordings

Simultaneous cerebral and spinal fluid pressure recordings

Studies of the Cerebrospinal Fluid Circulation in Tuberculous Meningits in Children: Part I. The Use of Penicillin as a Tracer Substance

Cerebrospinal fluid pressure dynamics reveal signs of effective spinal canal narrowing in ambiguous spine conditions

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