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However, opening pressures are notoriously unreliable when measured in the seated position. Therefore, patients will ideally lie on their side if practitioners need to measure opening pressure. [citation needed] Reinsertion of the stylet may decrease the rate of post lumbar puncture headaches. [15]
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury and at rest, is normally 7–15 mmHg for a supine adult. This equals to 9–20 cmH 2 O, which is a common scale used in lumbar punctures. [1]
Given normal anatomy, the intracranial pressure will be reflected as a rapidly rising pressure measured from the lumbar needle, within 10–12 seconds. If there is a stenosis in the spine, there will be a damped, delayed response in the lumbar pressure, thus a positive Queckenstedt's maneuver.
Lumbar puncture is performed to measure the opening pressure, as well as to obtain cerebrospinal fluid (CSF) to exclude alternative diagnoses. If the opening pressure is increased, CSF may be removed for transient relief (see below). [8] The CSF is examined for abnormal cells, infections, antibody levels, the glucose level, and protein levels.
The CSF tap test, sometimes lumbar tap test or Miller Fisher Test, is a medical test that is used to decide whether shunting of cerebrospinal fluid (CSF) would be helpful in a patient with suspected normal pressure hydrocephalus (NPH).
Patients with CSF leaks have been noted to have very low or even negative opening pressures during lumbar puncture. However, patients with confirmed CSF leaks may also demonstrate completely normal opening pressures. In 18–46% of cases, the CSF pressure is measured within the normal range.
A lumbar puncture that drains CSF may also be used as part of treatment for some conditions, including idiopathic intracranial hypertension and normal pressure hydrocephalus. [1] Lumbar puncture can also be performed to measure the intracranial pressure, which might be increased in certain types of hydrocephalus. However, a lumbar puncture ...
CSF flow can be used in diagnosing and treating aqueduct stenosis, normal pressure hydrocephalus, and Chiari malformation. [ 6 ] Aqueduct stenosis is the narrowing of the aqueduct of Sylvius which blocks the flow of CSF, causing fluid buildup in the brain called hydrocephalus.