Lumbar puncture in head injuries

Abstract

Based on a study of the anatomy and physiology of the brain, and on clinical experiences in a series of over 500 cases of head injuries with study of autopsy material together with a review of the literature on the subject, the following deductions are made: 1. 1. The withdrawal of cerebrospinal fluid by lumbar puncture as a diagnostic procedure should be performed in every case of head injury, after the patient has reacted from shock. The pressure should be recorded and the fluid collected in three tubes about 5 c.c. in each. If the fluid is uniformly bloody in the three tubes, and if the supernatant fluid is xanthocromic after centrifuging, and if the pressure is over 10–12 mm. of mercury, a diagnosis of intracranial injury with probable brain laceration or contusion and hemorrhage can be made. If the fluid is clear, but under increased pressure, and if there is other corroborating evidence, a diagnosis of traumatic cerebral edema can be made. If the fluid is clear and the pressure is normal, one is justified in ruling out an intracranial injury even in the presence of a fractured skull. 2. 2. Lumbar puncture is a useful therapeutic procedure in cases of traumatic edema. The pressure should be reduced by half the excess above normal, and the procedure repeated about every six to twelve hours until the pressure is normal. 3. 3. When the fluid is bloody and under increased pressure, no ill effects have been noted from repeated punctures, if the pressure is not reduced suddenly. 4. 4. Adoption of a uniform method of classifying head injuries will help to eliminate the confusion and conflicting opinions which now exist regarding diagnostic and therapeutic procedures and will render our statistics, especially regarding mortality, more reliable.