Q: During lumbar puncture (LP) the accurate cerebro-spinal fluid (CSF) pressure is measured with a manometer in a patient lying flat in the lateral decubitus position with the legs? (select one)
A) extended
B) flexed
Answer: A
Although controversy persists about the clinical significance but flexing the legs during the LP may falsely elevate the CSF pressure. An LP can be performed with the patient in the prone, lateral recumbent or sitting upright. The lateral recumbent or prone positions provides the most accurate measurement of the opening pressure. In lateral recumbent position, initially patient remains in the fetal position with the neck, back, and limbs held in flexion.
Once CSF begins to flow, the patient should be asked to slowly extend the legs. This allows the free flow of CSF within the subarachnoid space. A manometer then is placed over the hub of the needle and the opening pressure is measured.
Please refer to manuals for detailed proper positioning and technique.
#procedures
#neurology
References:
1. Rajagopal V, Lumsden DE. Best BETs from the Manchester Royal Infirmary. BET 4: does leg position alter cerebrospinal fluid opening pressure during lumbar puncture? Emerg Med J 2013; 30:771.
2.Abel AS, Brace JR, McKinney AM, et al. Effect of patient positioning on cerebrospinal fluid opening pressure. J Neuroophthalmol 2014; 34:218.
A) extended
B) flexed
Answer: A
Although controversy persists about the clinical significance but flexing the legs during the LP may falsely elevate the CSF pressure. An LP can be performed with the patient in the prone, lateral recumbent or sitting upright. The lateral recumbent or prone positions provides the most accurate measurement of the opening pressure. In lateral recumbent position, initially patient remains in the fetal position with the neck, back, and limbs held in flexion.
Once CSF begins to flow, the patient should be asked to slowly extend the legs. This allows the free flow of CSF within the subarachnoid space. A manometer then is placed over the hub of the needle and the opening pressure is measured.
Please refer to manuals for detailed proper positioning and technique.
#procedures
#neurology
References:
1. Rajagopal V, Lumsden DE. Best BETs from the Manchester Royal Infirmary. BET 4: does leg position alter cerebrospinal fluid opening pressure during lumbar puncture? Emerg Med J 2013; 30:771.
2.Abel AS, Brace JR, McKinney AM, et al. Effect of patient positioning on cerebrospinal fluid opening pressure. J Neuroophthalmol 2014; 34:218.
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