LISTSERV mailing list manager LISTSERV 16.5

Help for PED-EM-L Archives


PED-EM-L Archives

PED-EM-L Archives


PED-EM-L@LISTSERV.BROWN.EDU


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

PED-EM-L Home

PED-EM-L Home

PED-EM-L  September 1998

PED-EM-L September 1998

Subject:

Re: Herniation ? from LP.

From:

Bassam Gebara <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Thu, 3 Sep 1998 10:32:30 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (158 lines)

--------------0B2ECF855FB489E3783087B1
Content-Type: text/plain; charset=us-ascii
Content-Transfer-Encoding: 7bit
 
It is interesting that the discussion as to the relationship between LP and brain herniation has
not changed much in 40 years. I am looking at a paper from Neurology 1959;9:290-7 authored by
Julius Korein et al and entitled "Reevaluation of lumbar puncture, a study of 129 patients with
papilledema or intracranial hypertension". The authors performed a diagnostic LP in all patients
with papilledema or signs of increased ICP. They had 70 patients with papilledema (& increased
ICP) and 59 without papilledema but with signs of increased ICP. Most of these patients had
neoplasm or intracranial hemorrhage, only 6 had meningitis. They looked at all possible
complications of LP defined as any unfavorable change within 48 hrs of LP, regardless of the
opinion as to the cause. they found unfavorable changes in 1.4% in the group of papilledema (and
increased ICP) and 11.9% in the group without papilledema but increased ICP. These possible
complications were in patients with intracranial hemorrhage or neoplasm. None of the 6 meningitis
patients (4 with papilledema) had complications after the LP. They had a detailed discussion
about the patients with possible complications and concluded that these complications were
probably not caused by the LP.
 
Interesting paper from before the time of mechanical ventilation, imaging studies and ICU's.
 
Bassam Gebara, MD
Director, PICU
William Beaumont Hospital
 
Randolph J Cordle wrote:
 
> Hello,
>
> I have been following this unfortunate thread on this and the PICU list and
> have an academic question for the group.  What is the true evidence that the
> LP in the cases cited actually caused the herniation?  Certainly a temporal
> relationship has been suggested by the literature and I am not saying that
> cause and effect are not present, but I am not yet convinced that this is the
> case.  Obviously, this has serious medical and legal ramifications.  Could it
> be that the LP just happened to be done at about the time these children were
> going to herniate?  From a pure physics standpoint if you truly create this
> great lumbar vacuum why doesn't herniation occur immediately?  When it does I
> think the temporal argument speaks much more conclusively to cause and effect
> but when it is 12 or 24 hours later I think it is difficult to say.  I do not
> have the citation at my finger tips but I remember one of our pediatric
> neurosurgeons considering a lumbar, yes lumbar, drain on a pediatric trauma
> patient with increased uncontrollable elevated ICP because of recent
> literature demonstrating its ability to lower ICP even in patients with bolts
> already in the lateral ventricle ( Sorry, I do not remember all the
> specifics).
>
> I do not disagree with some of the suggested diagnostic and theraputic plans
> only with the evidence on which we may be basing our decisions and the
> possible legal ramifications to our colleagues who might practice differently
> based on the same literature.  If anyone knows of good literature proving
> cause and effect or statistically significant differences in outcome in
> matched cohorts please let me know.
>
> Respectfully,
> Randy Cordle MD
> Lehigh Valley Hospital
> Department of Emergency Medicine
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
 
 
 
--------------0B2ECF855FB489E3783087B1
Content-Type: text/html; charset=us-ascii
Content-Transfer-Encoding: 7bit
 
<HTML>
It is interesting that the discussion as to the relationship between LP
and brain herniation has not changed much in 40 years. I am looking at
a paper from Neurology 1959;9:290-7 authored by Julius Korein et al and
entitled "Reevaluation of lumbar puncture, a study of 129 patients with
papilledema or intracranial hypertension". The authors performed a diagnostic
LP in <B>all </B>patients with papilledema or signs of increased ICP. They
had 70 patients with papilledema (&amp; increased ICP) and 59 without papilledema
but with signs of increased ICP. Most of these patients had neoplasm or
intracranial hemorrhage, only 6 had meningitis. They looked at all possible
complications of LP defined as any unfavorable change within 48 hrs of
LP, regardless of the opinion as to the cause. they found unfavorable changes
in 1.4% in the group of papilledema (and increased ICP) and 11.9% in the
group without papilledema but increased ICP. These possible complications
were in patients with intracranial hemorrhage or neoplasm. None of the
6 meningitis patients (4 with papilledema) had complications after the
LP. They had a detailed discussion about the patients with possible complications
and concluded that these complications were probably not caused by the
LP.
 
<P>Interesting paper from before the time of mechanical ventilation, imaging
studies and ICU's.
 
<P>Bassam Gebara, MD
<BR>Director, PICU
<BR>William Beaumont Hospital
 
<P>Randolph J Cordle wrote:
<BLOCKQUOTE TYPE=CITE>Hello,
 
<P>I have been following this unfortunate thread on this and the PICU list
and
<BR>have an academic question for the group.&nbsp; What is the true evidence
that the
<BR>LP in the cases cited actually caused the herniation?&nbsp; Certainly
a temporal
<BR>relationship has been suggested by the literature and I am not saying
that
<BR>cause and effect are not present, but I am not yet convinced that this
is the
<BR>case.&nbsp; Obviously, this has serious medical and legal ramifications.&nbsp;
Could it
<BR>be that the LP just happened to be done at about the time these children
were
<BR>going to herniate?&nbsp; From a pure physics standpoint if you truly
create this
<BR>great lumbar vacuum why doesn't herniation occur immediately?&nbsp;
When it does I
<BR>think the temporal argument speaks much more conclusively to cause
and effect
<BR>but when it is 12 or 24 hours later I think it is difficult to say.&nbsp;
I do not
<BR>have the citation at my finger tips but I remember one of our pediatric
<BR>neurosurgeons considering a lumbar, yes lumbar, drain on a pediatric
trauma
<BR>patient with increased uncontrollable elevated ICP because of recent
<BR>literature demonstrating its ability to lower ICP even in patients
with bolts
<BR>already in the lateral ventricle ( Sorry, I do not remember all the
<BR>specifics).
 
<P>I do not disagree with some of the suggested diagnostic and theraputic
plans
<BR>only with the evidence on which we may be basing our decisions and
the
<BR>possible legal ramifications to our colleagues who might practice differently
<BR>based on the same literature.&nbsp; If anyone knows of good literature
proving
<BR>cause and effect or statistically significant differences in outcome
in
<BR>matched cohorts please let me know.
 
<P>Respectfully,
<BR>Randy Cordle MD
<BR>Lehigh Valley Hospital
<BR>Department of Emergency Medicine
 
<P>For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
<BR>The URL for the PED-EM-L Web Page is:
<BR>&nbsp; <A HREF="http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html">http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html</A></BLOCKQUOTE>
&nbsp;</HTML>
 
--------------0B2ECF855FB489E3783087B1--
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

Top of Message | Previous Page | Permalink

Advanced Options


Options

Log In

Log In

Get Password

Get Password


Search Archives

Search Archives


Subscribe or Unsubscribe

Subscribe or Unsubscribe


Archives

May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
July 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998
August 1998
July 1998
June 1998
May 1998
April 1998
March 1998
February 1998
January 1998
December 1997
November 1997
October 1997
September 1997
August 1997
July 1997
June 1997
May 1997
April 1997
March 1997
February 1997
January 1997
December 1996
November 1996
October 1996
September 1996
August 1996
July 1996
June 1996
May 1996
April 1996
March 1996
February 1996
January 1996
December 1995
November 1995
October 1995
September 1995
August 1995
July 1995
June 1995
May 1995
April 1995
March 1995
February 1995
January 1995
December 1994
November 1994
October 1994
September 1994

ATOM RSS1 RSS2



LISTSERV.BROWN.EDU

CataList Email List Search Powered by the LISTSERV Email List Manager