Effect Of Lumbar Puncture Research Articles

Effect of lumbar puncture on flow of cerebrospinal fluid.

The rate at which isotopes descend from the cisterna magna to the lumbar subarachnoid space is highly variable. In monkeys, with and without previous lumbar puncture, transit time was measured. In animals with a previous lumbar puncture, transit times were 10 to 120 minutes; in monkeys without a previous lumbar puncture, transit times were 120 to 180 minutes. In experimental studies of cerebrospinal fluid circulation, the effect of lumbar puncture must be controlled.

Evaluation of Neurotoxicity After Subarachnoid Injection of Large Volumes of Local Anesthetic Solutions

Recent case reports describing prolonged neurologic deficit after accidental spinal anesthesia with large volumes of 2-chloroprocaine have led to the suggestion that chloroprocaine may be more likely to cause such complications than other local anesthetics. We evaluated the neurologic effects of lumbar puncture alone and of large-volume subarachnoid administration of 2-chloroprocaine (3%), bupivacaine (0.75%), lidocaine (2%), Elliott's solution B (which is similar to CSF), or the carrier solution of 2-chloroprocaine (Nesacaine) in 48 sheep and 8 monkeys. Cerebrospinal fluid of sheep was collected on days 1 and 7 for biochemical and biological analyses, and CSF pressures of monkeys were recorded before and after injection. Animals were observed for neurologic deficits for seven days. Twelve sheep were unable to stand. Monkeys, on the other hand, had no apparent neurologic deficits. Autopsies revealed that 5 of the 12 sheep had lumbar subpial demyelination with macrophage infiltration: two of the five had received lidocaine; two received 2-chloroprocaine; and one had only a lumbar puncture. Two other sheep also had subpial demyelination: one had received lidocaine and one received 2-chloroprocaine. Three of the eight monkeys had lumbar subpial demyelination with macrophage invasion; two had received bupivacaine, and one received 2-chloroprocaine. No solution produced significant abnormalities in sheep CSF composition. We conclude that no local anesthetic or solution was more neurotoxic than another when injected in large volumes into the subarachnoid space of sheep or monkeys.

LUMBAR PUNCTURE AS A FACTOR IN THE PATHOGENESIS OF MENINGITIS

Meningitis is presumed to arise in one of three general ways: Organisms may reach the subarachnoid space by direct traumatic implantation; infection may extend to the meninges from an adjacent lesion, as in some cases of virulent mastoiditis with progression of the infection through the temporal bones, or organisms gaining access to the general circulation from a focus of infection at any site, however remote, may succeed in reaching the meninges by passing the blood-brain barrier. Lumbar puncture, performed for diagnosis, entails the risk of producing meningitis. The danger involved in a break in aseptic technic is clearly visualized and constantly borne in mind. Other dangers, related to the effect of lumbar puncture on the permeability of the blood-brain barrier and to the possibility of introducing bacteria-containing blood into the subarachnoid space, are less clearly understood and at times seem to be ignored. The uncertainty which surrounds the latter factors

ADMINISTRATION OF A PITUITARY EXTRACT AND HISTAMIN IN A CASE OF DIABETES INSIPIDUS

We have recently had the opportunity to study experimentally a rather severe case of diabetes insipidus. Our observations include the effect of lumbar puncture, the administration of pituitary extract hypodermically and by mouth, the effect of histamin injection, the nitrogenous metabolism before and as affected by pituitary extract, the blood constituents and the carbohydrate tolerance. REPORT OF CASE J. S., male, white, aged 24 years, single, a painter and mechanic, and an overseas man, was referred to the State University of Iowa Hospital, April 25, by Dr. F. H. Lamb of Davenport, Iowa, for chronic syphilis and polyuria. Family History. —The family history was unimportant; the patient stated, however, that one brother is a great water drinker. Present Illness. —The patient complained of loss of appetite, pain in the back and lower abdomen, occasional dimness of vision, dizziness, coldness and chills, polydipsia and polyuria, general weakness, and some loss in

REPORT OF A CASE OF DIABETES INSIPIDUS WITH MARKED REDUCTION IN THE AMOUNT OF URINE FOLLOWING LUMBAR PUNCTURE

This case of diabetes insipidus is reported because of the remarkable effect of lumbar puncture in diminishing the amount of urine and raising its specific gravity. A man of 43 had for four years the typical manifestations of diabetes insipidus. The urine varied in amount from 7,500 to 11,000 c.c., and was always of low specific gravity (1.001). Lumbar puncture was made and less than 5 c.c. of fluid withdrawn, the fluid escaping slowly under low pressure. Within forty-eight hours the daily amount of urine had dropped to 660 c.c. Headache, pain in the back of the neck, anorexia and vomiting, with a feeling of general weakness, followed the puncture. Morphin was given for pain. Almost no fluid or food was taken for three or four days. But after the prostration following the puncture had disappeared, when morphin was stopped, and when food and water were freely taken, there was