Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, August 11, 2016

CSF Opening Pressure

ALiEM - By Shenvi C - August 10th, 2016
LP manometer
"In Emergency Medicine, we are like Goldilocks when it comes to many things: We don’t like a patient’s PaO2 to be too high or too low. We don’t like the bed too high or too low when we intubate. We get concerned when we see a potassium that is too high or too low. The Goldilocks principle is also true of opening pressures on a lumbar puncture (LP). This post will discuss what the opening pressure means, and a differential diagnosis for when it is too high or too low and even when it is in the normal range.
Consider a case in which you are doing an LP for a patient with an abrupt onset headache who had a negative head CT. You nail the LP, but forget to measure the opening pressure. What do you do when the cerebrospinal fluid (CSF) lab studies come back with a champagne tap? You may consider further imaging with an MRI, or symptomatic management and observation. However, in some cases measuring the opening pressure could mean the difference between diagnosing or missing entities like CSF leaks, cerebral venous thrombosis, and idiopathic intracranial hypertension (IIH)...
  1. Always measure an opening pressure when doing an LP. Failing to do so could mean missing a clue to the diagnosis.
  2. Include the opening pressure value in your data set to help determine the cause of a patient’s symptoms.
  3. Remember the TAP AS IF mnemonic to help remember whether a head CT may be helpful before the LP."