腰穿与脑室外引流.ppt

* * Lumbar Puncture Circulation of Cerebrospinal Fluid It has been calculated that 430 to 450 ml of CSF are produced every day, so the fluid must be changes every 6 to 7 hours. lateral ventricles--? foramen of Monro third ventricle?-- aqueduct of Sylvius?--? fourth ventricle?--? foramina of Magendie and Luschka?--? subarachnoid space over brain and spinal cord?-- reabsorption into venous sinus blood via arachnoid granulations. Lumbar puncture Medical Uses Diagnostic Therapeutic Infectious diseases Inflammatory diseases Neoplastic diseases ?Subarachnoid hemorrhage Hydrocephalus Benign intracranial hypertension Routine for young infants with fever without a source ?Subarachnoid or ventricle hemorrhage Spinal anesthesia? Chemotherapy Lumbar puncture Contraindications Idiopathic (unidentified cause)?increased intracranial pressure?(ICP) Rationale: lumbar puncture in the presence of increased ICP may cause?herniation Exception: therapeutic use of lumbar puncture to reduce ICP, but only if obstruction (for example in the third ventricle of the brain) has been ruled out Precaution CT brain, especially in the following situations Age 65 Reduced?GCS Recent history of seizure Focal neurological signs Abnormal respiratory pattern Hypertension with deteriorating consciousness Bleeding diathesis?(relative) Coagulopathy Decreased?platelet?count (50 x 109/L) Infections Skin infection at puncture site Vertebral deformities (scoliosis), in hands of an inexperienced physician. Lumbar puncture Adverse effects Post spinal headache?with?nausea? Paresthesia in a leg during the procedure Serious complications Common complications Epidural bleeding Adhesive?arachnoiditis Trauma to the?spinal cord?or?spinal nerve?roots? Catastrophic epidural hemorrhage with abnormal dural arterio-venous malformations Technique and procedure Technique and procedure EVD (External ventricular drainage) The two main reasons EVDs are inserted are: 1) To divert infected CSF away from the brain and allow anti