What reactions may occur during lumbar puncture and how to deal with them
Feb 28, 2022
1. Low intracranial pressure syndrome: The cerebrospinal fluid pressure in the lateral decubitus position is below 0.58-0.78kPa (60-80mm water column), which is relatively common. Mostly because the puncture needle is too thick, the puncture technique is unskilled, or the patient gets up too early after surgery, which causes the continuous outflow of cerebrospinal fluid from the meningeal puncture hole. Headache, etc. can be relieved or relieved when lying down or head down. A few can still have disturbance of consciousness, mental symptoms, meningeal irritation, etc., which lasts for one to several days. Therefore, fine-needle aspiration should be used. After surgery, go to the pillow and lie down (preferably prone) for 4-6 hours, and drink plenty of boiled water (avoid drinking strong tea and sugar water), which can often be prevented. In addition to drinking more boiled water, 10-15ml of distilled water can also be injected intravenously or 500-1000ml of 5% grape brine, 1-2 times a day, for several days, as appropriate, and it can often be cured. It is also possible to inject 20-30ml of normal saline into the spinal canal or epidural again to eliminate the negative pressure in the epidural space to prevent the continued leakage of cerebrospinal fluid.
2. Brain herniation: When the intracranial pressure is increased (especially the posterior fovea and temporal space-occupying lesions), when the lumbar puncture fluid is too much and too fast, brain herniation can occur at the time of the puncture or within a few hours after the operation. Therefore, strict attention and prevention should be taken. If necessary, a dehydrating agent such as 20% mannitol solution 250ml can be rapidly injected intravenously before ordering, and then a few drops of cerebrospinal fluid can be slowly dropped by fine needle puncture for laboratory examination. If misfortune occurs, corresponding rescue measures should be taken immediately, such as intravenous injection of 200-400 ml of 20% mannitol and hypertonic diuretic dehydrating agent, etc. If necessary, fluid can also be punctured from the ventricle and the rapid injection of normal saline from the spinal canal40 -80ml, but generally more difficult to work.
3. Sudden aggravation of the symptoms of the original spinal cord and spinal nerve roots: more common in spinal cord compression, due to changes in pressure after lumbar puncture and discharge, resulting in changes in the pressure balance between spinal cord, nerve roots, cerebrospinal fluid and lesions in the spinal canal. It can aggravate symptoms such as radicular pain, paraplegia, and bowel and bladder disorders. In high cervical spinal cord compression, dyspnea and sudden arrest may occur. If the above symptoms are not serious, 30-50ml of normal saline can be injected into the spinal canal first: the effect is not effective. Best time to ask the surgeon to consider surgical treatment.
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