Epidural Space: Space between the dura mater and the walls of the vertebral canal.Spinal Puncture: Tapping fluid from the subarachnoid space in the lumbar region, usually between the third and fourth lumbar vertebrae.Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures.Post-Dural Puncture Headache: A secondary headache disorder attributed to low CEREBROSPINAL FLUID pressure caused by SPINAL PUNCTURE, usually after dural or lumbar puncture.Needles: Sharp instruments used for puncturing or suturing.Anesthesia, Epidural: Procedure in which an anesthetic is injected into the epidural space.Blood Patch, Epidural: The injection of autologous blood into the epidural space either as a prophylactic treatment immediately following an epidural puncture or for treatment of headache as a result of an epidural puncture.Meningitis: Inflammation of the coverings of the brain and/or spinal cord, which consist of the PIA MATER; ARACHNOID; and DURA MATER. Infections (viral, bacterial, and fungal) are the most common causes of this condition, but subarachnoid hemorrhage (HEMORRHAGES, SUBARACHNOID), chemical irritation (chemical MENINGITIS), granulomatous conditions, neoplastic conditions (CARCINOMATOUS MENINGITIS), and other inflammatory conditions may produce this syndrome. (From Joynt, Clinical Neurology, 1994, Ch24, p6)Dura Mater: The outermost of the three MENINGES, a fibrous membrane of connective tissue that covers the brain and the spinal cord.Injections, Epidural: The injection of drugs, most often analgesics, into the spinal canal without puncturing the dura mater.Cerebrospinal Fluid: A watery fluid that is continuously produced in the CHOROID PLEXUS and circulates around the surface of the BRAIN; SPINAL CORD; and in the CEREBRAL VENTRICLES.Lumbosacral Region: Region of the back including the LUMBAR VERTEBRAE, SACRUM, and nearby structures.Headache: The symptom of PAIN in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of HEADACHE DISORDERS.Ligamentum Flavum: The paired bands of yellow elastic tissue that connect adjoining laminae of the vertebrae. With the laminae, it forms the posterior wall of the spinal canal and helps hold the body erect.Myelography: X-ray visualization of the spinal cord following injection of contrast medium into the spinal arachnoid space.Spinal Canal: The cavity within the SPINAL COLUMN through which the SPINAL CORD passes.Analgesia, Epidural: The relief of pain without loss of consciousness through the introduction of an analgesic agent into the epidural space of the vertebral canal. It is differentiated from ANESTHESIA, EPIDURAL which refers to the state of insensitivity to sensation.Meningitis, Bacterial: Bacterial infections of the leptomeninges and subarachnoid space, frequently involving the cerebral cortex, cranial nerves, cerebral blood vessels, spinal cord, and nerve roots.Intracranial Hypotension: Reduction of CEREBROSPINAL FLUID pressure characterized clinically by HEADACHE which is maximal in an upright posture and occasionally by an abducens nerve palsy (see ABDUCENS NERVE DISEASES), neck stiffness, hearing loss (see DEAFNESS); NAUSEA; and other symptoms. This condition may be spontaneous or secondary to SPINAL PUNCTURE; NEUROSURGICAL PROCEDURES; DEHYDRATION; UREMIA; trauma (see also CRANIOCEREBRAL TRAUMA); and other processes. Chronic hypotension may be associated with subdural hematomas (see HEMATOMA, SUBDURAL) or hygromas. (From Semin Neurol 1996 Mar;16(1):5-10; Adams et al., Principles of Neurology, 6th ed, pp637-8)Neurosyphilis: Infections of the central nervous system caused by TREPONEMA PALLIDUM which present with a variety of clinical syndromes. The initial phase of infection usually causes a mild or asymptomatic meningeal reaction. The meningovascular form may present acutely as BRAIN INFARCTION. The infection may also remain subclinical for several years. Late syndromes include general paresis; TABES DORSALIS; meningeal syphilis; syphilitic OPTIC ATROPHY; and spinal syphilis. General paresis is characterized by progressive DEMENTIA; DYSARTHRIA; TREMOR; MYOCLONUS; SEIZURES; and Argyll-Robertson pupils. (Adams et al., Principles of Neurology, 6th ed, pp722-8)Seizures, Febrile: Seizures that occur during a febrile episode. It is a common condition, affecting 2-5% of children aged 3 months to five years. An autosomal dominant pattern of inheritance has been identified in some families. The majority are simple febrile seizures (generally defined as generalized onset, single seizures with a duration of less than 30 minutes). Complex febrile seizures are characterized by focal onset, duration greater than 30 minutes, and/or more than one seizure in a 24 hour period. The likelihood of developing epilepsy (i.e., a nonfebrile seizure disorder) following simple febrile seizures is low. Complex febrile seizures are associated with a moderately increased incidence of epilepsy. (From Menkes, Textbook of Child Neurology, 5th ed, p784)Injections, Spinal: Introduction of therapeutic agents into the spinal region using a needle and syringe.Lumbar Vertebrae: VERTEBRAE in the region of the lower BACK below the THORACIC VERTEBRAE and above the SACRAL VERTEBRAE.Cerebrospinal Fluid Pressure: Manometric pressure of the CEREBROSPINAL FLUID as measured by lumbar, cerebroventricular, or cisternal puncture. Within the cranial cavity it is called INTRACRANIAL PRESSURE.Epidural Neoplasms: Neoplasms located in the space between the vertebral PERIOSTEUM and DURA MATER surrounding the SPINAL CORD. Tumors in this location are most often metastatic in origin and may cause neurologic deficits by mass effect on the spinal cord or nerve roots or by interfering with blood supply to the spinal cord.Fluoroscopy: Production of an image when x-rays strike a fluorescent screen.Pseudotumor Cerebri: A condition marked by raised intracranial pressure and characterized clinically by HEADACHES; NAUSEA; PAPILLEDEMA, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile TINNITUS. OBESITY is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic PAPILLEDEMA may lead to optic nerve injury (see OPTIC NERVE DISEASES) and visual loss (see BLINDNESS).Subarachnoid Hemorrhage: Bleeding into the intracranial or spinal SUBARACHNOID SPACE, most resulting from INTRACRANIAL ANEURYSM rupture. It can occur after traumatic injuries (SUBARACHNOID HEMORRHAGE, TRAUMATIC). Clinical features include HEADACHE; NAUSEA; VOMITING, nuchal rigidity, variable neurological deficits and reduced mental status.Cerebrospinal Fluid Proteins: Proteins in the cerebrospinal fluid, normally albumin and globulin present in the ratio of 8 to 1. Increases in protein levels are of diagnostic value in neurological diseases. (Brain and Bannister's Clinical Neurology, 7th ed, p221)Tomography, X-Ray Computed: Tomography using x-ray transmission and a computer algorithm to reconstruct the image.Analgesia, Obstetrical: The elimination of PAIN, without the loss of CONSCIOUSNESS, during OBSTETRIC LABOR; OBSTETRIC DELIVERY; or the POSTPARTUM PERIOD, usually through the administration of ANALGESICS.Meningitis, Fungal: Meningitis caused by fungal agents which may occur as OPPORTUNISTIC INFECTIONS or arise in immunocompetent hosts.Radiculopathy: Disease involving a spinal nerve root (see SPINAL NERVE ROOTS) which may result from compression related to INTERVERTEBRAL DISK DISPLACEMENT; SPINAL CORD INJURIES; SPINAL DISEASES; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root.Lipomatosis: A disorder characterized by the accumulation of encapsulated or unencapsulated tumor-like fatty tissue resembling LIPOMA.Spinal Nerve Roots: Paired bundles of NERVE FIBERS entering and leaving the SPINAL CORD at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots are efferent, comprising the axons of spinal motor and PREGANGLIONIC AUTONOMIC FIBERS.Coccyx: The last bone in the VERTEBRAL COLUMN in tailless primates considered to be a vestigial tail-bone consisting of three to five fused VERTEBRAE.Anesthesia, Obstetrical: A variety of anesthetic methods such as EPIDURAL ANESTHESIA used to control the pain of childbirth.Spinal Cord: A cylindrical column of tissue that lies within the vertebral canal. It is composed of WHITE MATTER and GRAY MATTER.Thoracic Vertebrae: A group of twelve VERTEBRAE connected to the ribs that support the upper trunk region.Reagins: Antibodies, especially IGE, that bind to tissue of the same species so that ANTIGENS induce release of HISTAMINE and other vasoactive agents. HYPERSENSITIVITY is the clinical manifestation.Tissue Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound.Spinal DiseasesFiber Optic Technology: The technology of transmitting light over long distances through strands of glass or other transparent material.Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques.Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity.Laminectomy: A surgical procedure that entails removing all (laminectomy) or part (laminotomy) of selected vertebral lamina to relieve pressure on the SPINAL CORD and/or SPINAL NERVE ROOTS. Vertebral lamina is the thin flattened posterior wall of vertebral arch that forms the vertebral foramen through which pass the spinal cord and nerve roots.Anesthetics, Local: Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate.Mathematical Concepts: Numeric or quantitative entities, descriptions, properties, relationships, operations, and events.Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions.Intervertebral Disc Displacement: An INTERVERTEBRAL DISC in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region.Meningitis, Aseptic: A syndrome characterized by headache, neck stiffness, low grade fever, and CSF lymphocytic pleocytosis in the absence of an acute bacterial pathogen. Viral meningitis is the most frequent cause although MYCOPLASMA INFECTIONS; RICKETTSIA INFECTIONS; diagnostic or therapeutic procedures; NEOPLASTIC PROCESSES; septic perimeningeal foci; and other conditions may result in this syndrome. (From Adams et al., Principles of Neurology, 6th ed, p745)Anesthesia, Spinal: Procedure in which an anesthetic is injected directly into the spinal cord.Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, INTRACRANIAL HYPERTENSION; HEADACHE; lethargy; URINARY INCONTINENCE; and ATAXIA.Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including HYDROCEPHALUS; BRAIN EDEMA; intracranial masses; severe systemic HYPERTENSION; PSEUDOTUMOR CEREBRI; and other disorders.Cerebrospinal Fluid Shunts: Tubes inserted to create communication between a cerebral ventricle and the internal jugular vein. Their emplacement permits draining of cerebrospinal fluid for relief of hydrocephalus or other condition leading to fluid accumulation in the ventricles.Encephalocele: Brain tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur.Spinal Cord Compression: Acute and chronic conditions characterized by external mechanical compression of the SPINAL CORD due to extramedullary neoplasm; EPIDURAL ABSCESS; SPINAL FRACTURES; bony deformities of the vertebral bodies; and other conditions. Clinical manifestations vary with the anatomic site of the lesion and may include localized pain, weakness, sensory loss, incontinence, and impotence.Epidural Abscess: Circumscribed collections of suppurative material occurring in the spinal or intracranial EPIDURAL SPACE. The majority of epidural abscesses occur in the spinal canal and are associated with OSTEOMYELITIS of a vertebral body; ANALGESIA, EPIDURAL; and other conditions. Clinical manifestations include local and radicular pain, weakness, sensory loss, URINARY INCONTINENCE, and FECAL INCONTINENCE. Cranial epidural abscesses are usually associated with OSTEOMYELITIS of a cranial bone, SINUSITIS, or OTITIS MEDIA. (From Adams et al., Principles of Neurology, 6th ed, p710 and pp1240-1; J Neurol Neurosurg Psychiatry 1998 Aug;65(2):209-12)Spinal NeoplasmsCentral Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA VIRUS INFECTIONS; RNA VIRUS INFECTIONS; BACTERIAL INFECTIONS; MYCOPLASMA INFECTIONS; SPIROCHAETALES INFECTIONS; fungal infections; PROTOZOAN INFECTIONS; HELMINTHIASIS; and PRION DISEASES may involve the central nervous system as a primary or secondary process.Meningitis, Viral: Viral infections of the leptomeninges and subarachnoid space. TOGAVIRIDAE INFECTIONS; FLAVIVIRIDAE INFECTIONS; RUBELLA; BUNYAVIRIDAE INFECTIONS; ORBIVIRUS infections; PICORNAVIRIDAE INFECTIONS; ORTHOMYXOVIRIDAE INFECTIONS; RHABDOVIRIDAE INFECTIONS; ARENAVIRIDAE INFECTIONS; HERPESVIRIDAE INFECTIONS; ADENOVIRIDAE INFECTIONS; JC VIRUS infections; and RETROVIRIDAE INFECTIONS may cause this form of meningitis. Clinical manifestations include fever, headache, neck pain, vomiting, PHOTOPHOBIA, and signs of meningeal irritation. (From Joynt, Clinical Neurology, 1996, Ch26, pp1-3)Anesthesia, Caudal: Epidural anesthesia administered via the sacral canal.Anatomy, Cross-Sectional: Descriptive anatomy based on three-dimensional imaging (IMAGING, THREE-DIMENSIONAL) of the body, organs, and structures using a series of computer multiplane sections, displayed by transverse, coronal, and sagittal analyses. It is essential to accurate interpretation by the radiologist of such techniques as ultrasonic diagnosis, MAGNETIC RESONANCE IMAGING, and computed tomography (TOMOGRAPHY, X-RAY COMPUTED). (From Lane & Sharfaei, Modern Sectional Anatomy, 1992, Preface)Leukocytosis: A transient increase in the number of leukocytes in a body fluid.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Papilledema: Swelling of the OPTIC DISK, usually in association with increased intracranial pressure, characterized by hyperemia, blurring of the disk margins, microhemorrhages, blind spot enlargement, and engorgement of retinal veins. Chronic papilledema may cause OPTIC ATROPHY and visual loss. (Miller et al., Clinical Neuro-Ophthalmology, 4th ed, p175)Pneumocephalus: Presence of air or gas within the intracranial cavity (e.g., epidural space, subdural space, intracerebral, etc.) which may result from traumatic injuries, fistulous tract formation, erosions of the skull from NEOPLASMS or infection, NEUROSURGICAL PROCEDURES, and other conditions.Sepsis: Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by HYPOTENSION despite adequate fluid infusion, it is called SEPTIC SHOCK.Subarachnoid Space: The space between the arachnoid membrane and PIA MATER, filled with CEREBROSPINAL FLUID. It contains large blood vessels that supply the BRAIN and SPINAL CORD.Cerebral Ventriculography: Radiography of the ventricular system of the brain after injection of air or other contrast medium directly into the cerebral ventricles. It is used also for x-ray computed tomography of the cerebral ventricles.Meningeal Carcinomatosis: Primary or secondary neoplasm in the ARACHNOID or SUBARACHNOID SPACE. It appears as a diffuse fibrotic thickening of the MENINGES associated with variable degrees of inflammation.Fentanyl: A potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Fentanyl is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1078)Bupivacaine: A widely used local anesthetic agent.Cervical Vertebrae: The first seven VERTEBRAE of the SPINAL COLUMN, which correspond to the VERTEBRAE of the NECK.Ethmoid Bone: A light and spongy (pneumatized) bone that lies between the orbital part of FRONTAL BONE and the anterior of SPHENOID BONE. Ethmoid bone separates the ORBIT from the ETHMOID SINUS. It consists of a horizontal plate, a perpendicular plate, and two lateral labyrinths.Endoscopy: Procedures of applying ENDOSCOPES for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. transluminal, to examine or perform surgery on the interior parts of the body.Cerebrospinal Fluid Rhinorrhea: Discharge of cerebrospinal fluid through the nose. Common etiologies include trauma, neoplasms, and prior surgery, although the condition may occur spontaneously. (Otolaryngol Head Neck Surg 1997 Apr;116(4):442-9)Subdural Effusion: Leakage and accumulation of CEREBROSPINAL FLUID in the subdural space which may be associated with an infectious process; CRANIOCEREBRAL TRAUMA; BRAIN NEOPLASMS; INTRACRANIAL HYPOTENSION; and other conditions.Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of PROCAINE but its duration of action is shorter than that of BUPIVACAINE or PRILOCAINE.Headache Disorders: Various conditions with the symptom of HEADACHE. Headache disorders are classified into major groups, such as PRIMARY HEADACHE DISORDERS (based on characteristics of their headache symptoms) and SECONDARY HEADACHE DISORDERS (based on their etiologies). (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1)Nerve Block: Interruption of NEURAL CONDUCTION in peripheral nerves or nerve trunks by the injection of a local anesthetic agent (e.g., LIDOCAINE; PHENOL; BOTULINUM TOXINS) to manage or treat pain.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons.Spinal Cord Diseases: Pathologic conditions which feature SPINAL CORD damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Spinal Stenosis: Narrowing of the spinal canal.Cecum: The blind sac or outpouching area of the LARGE INTESTINE that is below the entrance of the SMALL INTESTINE. It has a worm-like extension, the vermiform APPENDIX.Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous SPRAINS AND STRAINS; INTERVERTEBRAL DISK DISPLACEMENT; and other conditions.Central Nervous System Protozoal Infections: Infections of the brain, spinal cord, or meninges by single celled organisms of the former subkingdom known as protozoa. The central nervous system may be the primary or secondary site of protozoal infection. These diseases may occur as OPPORTUNISTIC INFECTIONS or arise in immunocompetent hosts.Meningitis, Meningococcal: A fulminant infection of the meninges and subarachnoid fluid by the bacterium NEISSERIA MENINGITIDIS, producing diffuse inflammation and peri-meningeal venous thromboses. Clinical manifestations include FEVER, nuchal rigidity, SEIZURES, severe HEADACHE, petechial rash, stupor, focal neurologic deficits, HYDROCEPHALUS, and COMA. The organism is usually transmitted via nasopharyngeal secretions and is a leading cause of meningitis in children and young adults. Organisms from Neisseria meningitidis serogroups A, B, C, Y, and W-135 have been reported to cause meningitis. (From Adams et al., Principles of Neurology, 6th ed, pp689-701; Curr Opin Pediatr 1998 Feb;10(1):13-8)Steroids: A group of polycyclic compounds closely related biochemically to TERPENES. They include cholesterol, numerous hormones, precursors of certain vitamins, bile acids, alcohols (STEROLS), and certain natural drugs and poisons. Steroids have a common nucleus, a fused, reduced 17-carbon atom ring system, cyclopentanoperhydrophenanthrene. Most steroids also have two methyl groups and an aliphatic side-chain attached to the nucleus. (From Hawley's Condensed Chemical Dictionary, 11th ed)Emergency Medicine: The branch of medicine concerned with the evaluation and initial treatment of urgent and emergent medical problems, such as those caused by accidents, trauma, sudden illness, poisoning, or disasters. Emergency medical care can be provided at the hospital or at sites outside the medical facility.Erythrocyte Count: The number of RED BLOOD CELLS per unit volume in a sample of venous BLOOD.Meningitis, Pneumococcal: An acute purulent infection of the meninges and subarachnoid space caused by Streptococcus pneumoniae, most prevalent in children and adults over the age of 60. This illness may be associated with OTITIS MEDIA; MASTOIDITIS; SINUSITIS; RESPIRATORY TRACT INFECTIONS; sickle cell disease (ANEMIA, SICKLE CELL); skull fractures; and other disorders. Clinical manifestations include FEVER; HEADACHE; neck stiffness; and somnolence followed by SEIZURES; focal neurologic deficits (notably DEAFNESS); and COMA. (From Miller et al., Merritt's Textbook of Neurology, 9th ed, p111)Meningitis, Cryptococcal: Meningeal inflammation produced by CRYPTOCOCCUS NEOFORMANS, an encapsulated yeast that tends to infect individuals with ACQUIRED IMMUNODEFICIENCY SYNDROME and other immunocompromised states. The organism enters the body through the respiratory tract, but symptomatic infections are usually limited to the lungs and nervous system. The organism may also produce parenchymal brain lesions (torulomas). Clinically, the course is subacute and may feature HEADACHE; NAUSEA; PHOTOPHOBIA; focal neurologic deficits; SEIZURES; cranial neuropathies; and HYDROCEPHALUS. (From Adams et al., Principles of Neurology, 6th ed, pp721-2)Hematoma, Subdural: Accumulation of blood in the SUBDURAL SPACE between the DURA MATER and the arachnoidal layer of the MENINGES. This condition primarily occurs over the surface of a CEREBRAL HEMISPHERE, but may develop in the spinal canal (HEMATOMA, SUBDURAL, SPINAL). Subdural hematoma can be classified as the acute or the chronic form, with immediate or delayed symptom onset, respectively. Symptoms may include loss of consciousness, severe HEADACHE, and deteriorating mental status.Pregnancy Trimester, Third: The last third of a human PREGNANCY, from the beginning of the 29th through the 42nd completed week (197 to 294 days) of gestation.Lyme Neuroborreliosis: Nervous system infections caused by tick-borne spirochetes of the BORRELIA BURGDORFERI GROUP. The disease may affect elements of the central or peripheral nervous system in isolation or in combination. Common clinical manifestations include a lymphocytic meningitis, cranial neuropathy (most often a facial neuropathy), POLYRADICULOPATHY, and a mild loss of memory and other cognitive functions. Less often more extensive inflammation involving the central nervous system (encephalomyelitis) may occur. In the peripheral nervous system, B. burgdorferi infection is associated with mononeuritis multiplex and polyradiculoneuritis. (From J Neurol Sci 1998 Jan 8;153(2):182-91)Meninges: The three membranes that cover the BRAIN and the SPINAL CORD. They are the dura mater, the arachnoid, and the pia mater.Atrial Septum: The thin membrane-like muscular structure separating the right and the left upper chambers (HEART ATRIA) of a heart.
Lumbar puncture is carried out under sterile conditions by inserting a needle into the subarachnoid space, usually between the ... Treatment of an identified leak may include injection of a person's blood into the epidural space (an epidural blood patch), ... A lumbar puncture that drains CSF may also be used as part of treatment for some conditions, including idiopathic intracranial ... CSF can leak from the dura as a result of different causes such as physical trauma or a lumbar puncture, or from no known cause ...
The dura is pierced during a lumbar puncture (spinal tap), and epidural anesthesia is injected into the just outside the thecal ... The lumbar cistern within the thecal sac is the subarachnoid space below the end of the spinal cord and above the tapering of ... Lumbar Puncture". In Richard W. Dehn and David P. Asprey. Essential Clinical Procedures: Expert Consult - Online and Print. ... Along most of the spinal canal it is separated from the inner surface by the epidural space. The sac has projections that ...
The subarachnoid space contains cerebrospinal fluid (CSF), which can be sampled with a lumbar puncture, or "spinal tap" ... Between the dura mater and the surrounding bone of the vertebrae is a space called the epidural space. The epidural space is ... Lumbar punctures in adults are usually performed between L3-L5 (cauda equina level) in order to avoid damage to the spinal cord ... The space between the arachnoid and the underlying pia mater is called the subarachnoid space. ...
Combined spinal and epidural anaesthesia Epidural Intrathecal administration Lumbar puncture Bronwen Jean Bryant; Kathleen Mary ... secondary to an increased risk of a spinal epidural hematoma) Space occupying lesions of the brain Anatomical disorders of the ... Transparent reality simulation of spinal anaesthesia Various diagrams of needles for Lumbar puncture, Epidural, Spinal ... An epidural may be given at a cervical, thoracic, or lumbar site, while a spinal must be injected below L2 to avoid piercing ...
The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture (spinal tap). A small amount of ... An epidural needle is inserted into the epidural space at the site of the cerebrospinal fluid leak and blood is injected. The ... the patient's blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then " ... The procedure carries the typical risks of any epidural puncture. However, even though it is often effective, further ...
Lumbar puncture is carried out under sterile conditions by inserting a needle into the subarachnoid space, usually between the ... Treatment of an identified leak may include injection of a person's blood into the epidural space (an epidural blood patch), ... CSF pressure, as measured by lumbar puncture, is 10-18 cmH2O (8-15 mmHg or 1.1-2 kPa) with the patient lying on the side and 20 ... Main article: Lumbar puncture. CSF can be tested for the diagnosis of a variety of neurological diseases, usually obtained by a ...
A small amount of the person's blood is injected into the epidural space near the site of the original puncture; the resulting ... It is a common side-effect of spinal anesthesia and lumbar puncture and may occasionally accidentally occur in epidural ... The procedure carries the typical risks of any epidural puncture. However, it is effective, and further intervention is rarely ... This approach can also prevent PDPH headaches caused by over-penetration during epidural anesthesia (where dural puncture was ...
The subarachnoid space contains cerebrospinal fluid (CSF). The medical procedure known as a lumbar puncture (or "spinal tap") ... Between the dura mater and the surrounding bone of the vertebrae is a space called the epidural space. The epidural space is ... The space between the arachnoid and the underlying pia mater is called the subarachnoid space. ... involves use of a needle to withdraw cerebrospinal fluid from the subarachnoid space, usually from the lumbar region of the ...
Accidental dural puncture with headache (common, about 1 in 100 insertions). The epidural space in the adult lumbar ... Epidural administration. A freshly inserted lumbar epidural catheter. The site has been prepared with tincture of iodine, and ... Caudal epidural analgesia. The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous ... This may cause cerebrospinal fluid (CSF) to leak out into the epidural space, which may in turn cause a post dural puncture ...
Accidental dural puncture with headache (common, about 1 in 100 insertions). The epidural space in the adult lumbar spine is ... This may cause cerebrospinal fluid (CSF) to leak out into the epidural space, which may in turn cause a post dural puncture ... Epidural techniques frequently involve injection of drugs through a catheter placed into the epidural space. The injection can ... The catheter is a fine plastic tube, through which anaesthetics may be injected into the epidural space. Many epidural ...
The diagnosis is generally confirmed with a CT scan of the head, or occasionally by lumbar puncture. Treatment is by prompt ... Epidural hematoma (EDH) is a rapidly accumulating hematoma between the dura mater and the cranium. These patients have a ... Subdural hemorrhage results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater. Head ... A subarachnoid hemorrhage is bleeding into the subarachnoid space-the area between the arachnoid membrane and the pia mater ...
This has been effective in identifying the sites of a CSF leak without the need for a CT scan, lumbar puncture, and contrast ... According to this theory, dural holes and intracranial hypotension are symptoms caused by low pressure in the epidural space ... The opening fluid pressure in the spinal canal is obtained by performing a lumbar puncture, also known as a spinal tap. Once ... Lumbar disc herniation has been reported to cause CSF leak in at least one case. Degenerative spinal disc diseases cause a disc ...
Lumbar puncture and cerebrospinal fluid analysis. Lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis are ... The spine most often is affected by metastatic disease involving the epidural space. This usually occurs as direct tumor spread ... The management of spinal cord metastasis depends on whether or not the metastasis is causing epidural spinal cord compression ... Pain is the first symptom in ,90% of patients presenting with epidural metastasis and occurs less frequently with intradural ...
Cerebrospinal fluid also exists within this space. Because the spinal cord terminates at level L1/L2, lumbar puncture (or ... epidural), narrowing of the spinal canal, postoperative lumbar spine surgery complications or spinal anesthesia. The cauda ... The cauda equina occupies the lumbar cistern, a subarachnoid space inferior to the conus medullaris. The nerves that compose ... In humans, the spinal cord stops growing in infancy and the end of the spinal cord is about the level of the third lumbar ...
The lumbar plexus block is an advanced technique indicated for hip, anterior thigh, and knee surgery. The lumbar plexus is ... Complications include pneumothorax, vascular puncture, hypotension, and pleural puncture. "About Regional Anesthesia / Nerve ... The paravertebral space is located a couple centimeters lateral to the spinous process and is bounded posteriorly by the ... Since it is a unilateral block, it may be chosen over epidurals for patients who can't tolerate the hypotension that follows ...
Lumbar puncture procedure, which is performed in many infectious disorders of the central nervous system is contraindicated in ... These symptoms are caused by a combination of increased intracranial pressure due to a space-occupying lesion (headache, ... epidural abscess) or remote (lung, heart, kidney etc.) infectious sources, within the brain tissue. The infection may also be ... the immature lesion does not have a capsule and it may be difficult to distinguish it from other space-occupying lesions or ...
Epidural anesthesia is an LA injected into the epidural space, where it acts primarily on the spinal nerve roots; depending on ... Diagnostic tests such as bone marrow aspiration, lumbar puncture (spinal tap) and aspiration of cysts or other structures are ... Epidural anesthesia by a caudal approach had been known in the early 20th century, but a well-defined technique using lumbar ... Heart and lung surgery (epidural anesthesia combined with general anesthesia). *Abdominal surgery (epidural anesthesia/spinal ...
If persistent intracranial hypotension is the result of a lumbar puncture, a "blood patch" may be applied to seal the site of ... For example, an increase in lesion volume (e.g. epidural hematoma) will be compensated by the downward displacement of CSF and ... Severely raised ICP, if caused by a unilateral space-occupying lesion (e.g. a hematoma) can result in midline shift, a ... More commonly, decreased ICP is the result of lumbar puncture or other medical procedures involving the brain or spinal cord. ...
Some diagnostic procedures, such as lumbar puncture (see post-dural-puncture headache), venipuncture, paracentesis, and ... A long-term epidural catheter may be inserted into this space for three to six months, to deliver anesthetics or analgesics. ... Between this and the surrounding vertebrae is the epidural space filled with connective tissue, fat and blood vessels and ... recommended with long-term use to reduce the chance of any infection at the exit site reaching the epidural space. Electrical ...
Through this needle, he introduced a 3.5 French ureteral catheter made of elastic silk into the lumbar epidural space. He then ... "James Leonard Corning and the early history of spinal puncture". Neurology. 37 (4): 672-4. doi:10.1212/WNL.37.4.672. PMID ... it is apparent that his injections were made into the epidural space, and not the subarachnoid space. Finally, Corning was ... The first described placement of a lumbar epidural catheter was performed by Pío Manuel María Martínez Curbelo (5 June 1906-1 ...
Epidural Lumbar puncture Combined spinal and epidural anaesthesia Intrathecal administration "Pregnancy Labor and Birth". ... An epidural is a procedure that involves placing a tube (catheter) into the lower back, into a small space below the spinal ... But women in labor often shiver with or without an epidural. If the covering of the spinal chord is punctured by the catheter, ... An epidural can cause a backache that can occur for a few days after labor. An epidural can prolong the first and second stages ...
... it is apparent that his injections were made into the epidural space, and not the subarachnoid space. Finally, Corning was ... The following year, Corning injected cocaine between the spinous processes of the lower lumbar vertebrae, first in a dog and ... "James Leonard Corning and the early history of spinal puncture (abstract)". Neurology. 37 (4): 672-4. doi:10.1212/WNL.37.4.672 ... The controversy centers around whether Corning's injection was a spinal or an epidural block. The dose of cocaine used by ...
If drilling or dural puncture is not successful, the surgeon may dissect away dura and create a secondary bleed known as an ... In draining the ventricle, the EVD can also remove blood products from the ventricular spaces. This is important because blood ... External Ventricular Drainage or Lumbar Drainage". AANN Clinical Practice Guideline Series. American Association of ... epidural or subdural hemorrhage. Bleeding from EVD placement can be life-threatening and can require neurosurgical intervention ...
Lumbar puncture. A lumbar puncture in progress. A large area on the back has been washed with an iodine-based ... The initial procedure is usually a lumboperitoneal (LP) shunt, which connects the subarachnoid space in the lumbar spine with ... These criteria also require that the lumbar puncture is performed with patient lying sideways, as a lumbar puncture performed ... Lumbar puncture is performed to measure the opening pressure, as well as to obtain cerebrospinal fluid (CSF) to exclude ...
A lumbar puncture may be useful to diagnose a central nervous system infection but is not routinely needed. Routine ... space-occupying lesions in the brain (abscesses, tumours). In people with brain tumours, the frequency of epilepsy depends on ... Depending on the presumed cause blood tests and lumbar puncture may be useful. Hypoglycemia may cause seizures and should be ... "Stress and Seizures: Space, Time and Hippocampal Circuits". Trends in Neurosciences. 40 (11): 667-679. doi:10.1016/j.tins. ...
... is a principle in epidural anaesthesia first described by Professor Achille Mario Dogliotti in 1933. It is a method for the identification of the epidural space, a potential space. As a needle is advanced through the ligamentum flavum, to the epidural space, with constant pressure applied to the piston of a syringe, loss of resistance occurs once the needle enters the epidural space due to the change in pressure. The identification of this space, allows subsequent administration of epidural anaesthesia, a technique used primarily for analgesia during childbirth. This technique remains in use at present[update], and is commonly referred to the loss of resistance to saline technique (LORS) or its variation, the loss of resistance to air technique (LORA). ...
... is bleeding into the epidural space in the spine. These may arise spontaneously (e.g. during childbirth), or as a rare complication of epiduralanaesthesia or of surgery (such as laminectomy). Symptoms usually include back pain which radiates to the arms or the legs. They may cause pressure on the spinal cord or cauda equina, which may present as pain, muscle weakness, or dysfunction of the bladder and bowel. The best way to confirm the diagnosis is MRI. Risk factors include anatomical abnormalities and bleeding disorders. Treatment is generally with emergency surgery. The risk following epidural anaesthesia is difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics. The anatomy of the epidural space is such that spinal ...
A Spinal Cord Stimulator (SCS) or Dorsal Column Stimulator (DCS) is a type of implantable neuromodulation device (sometimes called a "pain pacemaker") that is used to send electrical signals to select areas of the spinal cord (dorsal columns) for the treatment of certain pain conditions. SCS is a consideration for people who have a pain condition that has not responded to more conservative therapy. In the United States Failed Back Surgery Syndrome is the most common use while in Europe the most common use is peripheral ischemia. As of 2014 the FDA had approved SCS as a treatment for failed back surgery syndrome (FBSS), chronic pain, Complex Regional Pain Syndrome, Intractable angina, as well as visceral abdominal and perineal pain and pain in the extremities from nerve damage. The most common use of SCS is failed back surgery syndrome (FBSS) in the United States and peripheral ischemic pain in Europe. Once a person has had a psychological evaluation and deemed an appropriate candidate for SCS, a ...
... is a rare disease that is most often seen in older obese black men with hypertension. In pelvic lipomatosis, abnormally dense deposits of otherwise apparently normal fat may be observed in the spaces of the pelvic area. Associated with cystitis glandularis, a precursor to adenocarcinoma of the urinary bladder. Fogg LB, Smyth JW. Pelvic lipomatosis: a condition simulating pelvic neoplasm. Radiology. 1968;90:558. http://www.medscape.com/viewarticle/417016_print An example of aggressive pelvic lipomatosis Lipoma ...
Procedures involving injection of any substance into the epidural space require the operator to be technically proficient in order to avoid complications.. The subject may be in the seated, lateral or prone positions. The level of the spine at which the catheter is best placed depends mainly on the site and type of an intended operation or the anatomical origin of pain. The iliac crest is a commonly used anatomical landmark for lumbar epidural injections, as this level roughly corresponds with the fourth lumbar vertebra, which is usually well below the termination of the spinal cord. The Tuohy needle is usually inserted in the midline, between the spinous processes. When using a paramedian approach, the tip of the needle passes along a shelf of vertebral bone called the lamina until just before reaching the ligamentum flavum and the epidural ...
... (from Ancient Greek ἐπί, "on, upon" + dura mater) is a medical route of administration in which a drug or contrast agent is injected into the epidural space of the spinal cord. Techniques such as epidural analgesia and epidural anaesthesia employ this route of administration. The epidural route is frequently employed by certain physicians and nurse anaesthetists to administer diagnostic (e.g. radiocontrast agents) and therapeutic (e.g., glucocorticoids) chemical substances, as well as certain analgesic and local anaesthetic agents. Epidural techniques frequently involve injection of drugs through a catheter placed into the epidural space. The injection can result in a loss of sensation-including the sensation of pain-by blocking the transmission of signals through nerve ...
The vertebral vein is formed in the suboccipital triangle, from numerous small tributaries which spring from the internal vertebral venous plexuses and issue from the vertebral canal above the posterior arch of the atlas. They unite with small veins from the deep muscles at the upper part of the back of the neck, and form a vessel which enters the foramen in the transverse process of the atlas, and descends, forming a dense plexus around the vertebral artery, in the canal formed by the foramina transversaria of the cervical vertebrae. This plexus ends in a single trunk, which emerges from the foramen transversarium of the sixth cervical vertebra, and opens at the root of the neck into the back part of the innominate vein near its origin, its mouth being guarded by a pair of valves. On the right side, it crosses the first part of the subclavian artery. Section of the neck at about the level of the sixth cervical vertebra. This article incorporates text in the public domain from the 20th edition ...
... is an abnormal increase in the amount of lymphocytes in the cerebrospinal fluid (CSF). It is usually considered to be a sign of infection or inflammation within the nervous system, and is encountered in a number of neurological diseases, such as pseudomigraine, Susac's syndrome, and encephalitis. While lymphocytes make up roughly a quarter of all white blood cells (WBC) in the body, they are generally rare in the CSF. Under normal conditions, there are usually less than 5 white blood cells per µL of CSF. In a pleocytic setting, the number of lymphocytes can jump to more than 1,000 cells per µL. Increases in lymphocyte count are often accompanied by an increase in cerebrospinal protein concentrations in addition to pleocytosis of other types of white blood cells. Determination of lymphocytic pleocytosis became possible with the advent of the diagnostic lumbar puncture and the technology necessary to analyze the cerebrospinal fluid via microbiological, biochemical, and ...
Historically, papilledema was a potential contraindication to lumbar puncture, as it indicates a risk for tentorial herniation and subsequent death via cerebral herniation, however newer imaging techniques have been more useful at determining when and when not to conduct a lumbar puncture. Imaging by CT or MRI is usually performed to elicit whether there is a structural cause i.e., tumor. An MRA and MRV may also be ordered to rule out the possibility of stenosis or thrombosis of the arterial or venous systems. The treatment depends largely on the underlying cause. However, the root cause of papilledema is the increased intracranial pressure (ICP). This is a dangerous sign, indicative of a brain tumor, CNS inflammation or idiopathic intracranial hypertension (IIH) that may become manifest in the near future. Thus, a biopsy is routinely performed prior to the treatment in the initial stages of papilledema to detect whether a brain tumor is ...
A radionuclide cisternogram is a medical imaging study which involves injecting a radionuclide by lumbar puncture (spinal tap) into a patient's cerebral spinal fluid (CSF) to determine if there is abnormal CSF flow within the brain and spinal canal which can be altered by hydrocephalus, Arnold-Chiari malformation, syringomyelia, or an arachnoid cyst. It may also evaluate a suspected leak (also known as a CSF fistula) from the CSF cavity into the nasal cavity. A leak can also be confirmed by the presence of beta-2 transferrin in fluid collected from the nose before this more invasive procedure is performed. The patient may be instructed to not eat or drink, or take medications such as aspirin or other blood thinners before the procedure. Pledgets can be inserted into the nasal cavity before the procedure when a CSF leak is suspected. The patient's spinal fluid is injected with a radiopharmaceutical tracer, such as DTPA tagged with indium 111, through a lumbar ...
... (PDPH) is a complication of puncture of the dura mater (one of the membranes that surround the brain and spinal cord). The headache is severe and described as "searing and spreading like hot metal," involving the back and front of the head, and spreading to the neck and shoulders, sometimes involving neck stiffness. It is exacerbated by movement, and sitting or standing, and relieved to some degree by lying down. Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are common. It is a common side-effect of spinal anesthesia and lumbar puncture. Leakage of cerebrospinal fluid puncture causes reduced fluid levels in the brain and spinal cord. Onset occurs within two days in 66 percent and within three days in ninety percent of PDPH cases. It occurs so rarely immediately after puncture that other possible causes should be investigated when it does. Using ...
Grades I and II are most common, and often there are no further complications. Grades III and IV are the most serious and may result in long-term brain injury to the infant. After a grade III or IV IVH, blood clots may form which can block the flow of cerebrospinal fluid, leading to increased fluid in the brain (hydrocephalus). There have been various therapies employed into preventing the high rates of morbidity and mortality, including diuretic therapy, repeated lumbar puncture, streptokinase therapy  and most recently combination a novel intervention called DRIFT (drainage, irrigation and fibrinolytic therapy). In 2002, a Dutch retrospective study analysed cases where neonatologists had intervened and drained CSF by lumbar or ventricular punctures if ventricular width (as shown on ultrasound) exceeded the 97th centile as opposed to the 97th centile plus 4 mm. Professors Whitelaw's original Cochrane review published ...
As the patient is put in Trendelenburg position, the blood patch distributes along the epidural space and clots at the site of ... 2 Intracranial hypotension can also be precipitated by direct trauma or iatrogenic causes such as a lumbar puncture. The ... 6 The treatment involves placing 10 to 20 mL of autologous blood in the epidural space at the thoracolumbar level. ... Figure 1. (a) Computed tomography of the brain (axial view) showing a normal brain with adequate space over the midbrain and ...
Lumbar punctures and epidural catheterisations are common procedures used to access the subarachnoid and epidural spaces. ... Randomly assigned patients undergoing lumbar punctures or epidural catheterisations in the lumbar region ... Comparison of ultrasound-assisted lumbar puncture with lumbar puncture using palpation of landmarks in aged patients in an ... Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ 2013; 346 doi: ...
... clinicaltrials.gov Accidental dural puncture is a potential complication of epidural analgesia for labour and delivery. When it ... Effective epidural analgesia depends on accurate identification of the epidural space for delivery of analgesic mixtures. The ... Lumbar Spine Ultrasound of Patients With Previous Accidental Dural Puncture During Labour Epidural. 2014-08-27 03:38:55 , ... More From BioPortfolio on "Lumbar Spine Ultrasound of Patients With Previous Accidental Dural Puncture During Labour Epidural" ...
Ultrasound Guided Lumbar Puncture. Preparation. Consent Lateral decubitus position Arch lower back with knees drawn to chest ... 5 structures (spinous processes, ligamentum flavum, dura, epidural space, subarachnoid space). *76 patients, all landmarks ... Postdural Puncture Headache and Epidural Blood Patch -. presented by r3 簡維宏. postdural puncture headache (i). any breach of the ... Ultrasound Guided Lumbar Puncture. Preparation. Consent Lateral decubitus position Arch lower back with knees drawn to chest ...
Total failure was described as failure of localization of subarachnoid space with lumbar puncture; no motor and / or sensory ... Patients who underwent combined spinal-epidural anesthesia and patients without consent were excluded. The primary aim of the ... 1. Failure of localization of subarachnoid space with lumbar puncture and conversion from spinal anesthesia to general ... the level of puncture, the type of spinal needle, the direction of the spinal needle notch, the number of spinal puncture, the ...
A range of interchangeable puncture blocks is supplied to simulate elderly and obese patients. ... Designed for hands-on training and assessment in lumbar puncture and epidural procedures. ... Evaluation of M43B Lumbar puncture simulator-II as a training tool for identification of the epidural space and lumbar puncture ... "Evaluation of M43B Lumbar puncture simulator-II as a training tool for identification of the epidural space and lumbar puncture ...
Lumbar Puncture Model offers realistic and repeatable training in the core skills of Lumbar Puncture and Epidural Anaesthesia. ... Optional steeper spine and smaller vertebral spaces. Versatility. *All inserts compatible with common base ... Epidural & Lumbar Puncture Standard Dura (x2). Yes. Yes. Yes. 61018. Epidural & Lumbar Puncture Advanced Dura (x4). Yes. No. ... Epidural & Lumbar Puncture Iliac Crest Insert. Yes. Yes. Yes. 61020. Epidural & Lumbar Puncture Insert Cartridge. Yes. Yes. Yes ...
By additional screening further metastases were detected in the thoracal and lumbal spine and surprisingly also in the lung and ... cervical muscles and epidural space in a young patient - case report and review of literature. ... Lumbar puncture was made with no pathological result. The abdomen CT showed no pathological findings. Postoperativly the ... Both, the epidural (emetGB IV°) as well as the pulmonal (pmetGB IV°) metastasis demonstrate expression of GFAP in 10-20% and of ...
The simulator features the lumbar vertebrae, iliac crest, spinous process, ligamentum flavum, the epidural space and dura; ... The Obese Adult Replaceable Lumbar Puncture and Epidural Tissues feature increased soft tissue ... Our ultrasound lumbar puncture trainer realistically simulates an obese patient. ... Lumbar Puncture/Epidural. *Obese Lumbar Puncture / Epidural Training Package. Obese Lumbar Puncture / Epidural Training Package ...
The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture (spinal tap). A small amount of ... An epidural needle is inserted into the epidural space at the site of the cerebrospinal fluid leak and blood is injected. The ... the patients blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then " ... The procedure carries the typical risks of any epidural puncture. However, even though it is often effective, further ...
Clinical suspicion for SIH can be confirmed by demonstrating low opening pressure on lumbar puncture or with imaging.6 Brain MR ... Epidural puncture in these regions is technically more challenging due the anatomy and the epidural space becoming smaller as ... An additional access site in the epidural space of the lower lumbar spine by using a 19-gauge spinal needle was obtained if ... Additionally, this treatment avoids puncture of the epidural space in the thoracic and cervical spine, making it theoretically ...
The intrathecal space is entered during several diagnostic and therapeutic spinal procedures, including lumbar puncture, ... used by health-care providers who were either placing a catheter or injecting material into the spinal canal or epidural space ... Veringa E, Van Belkum A, Schellekens H. Iatrogenic meningitis by Streptococcus salivarius following lumbar puncture. J Hosp ... Pandian JD, Sarada C, Radhakrishnan VV, Kishore A. Iatrogenic meningitis after lumbar puncture-a preventable health hazard. J ...
Monitoring pressure from the lumbar subarachnoid space can be done only in instances where lumbar puncture does not pose a ... bone and the epidural space; and patients who have demonstrated blockage of cerebrospinal fluid to the subarachnoid space due ... In addition, when the ventricle or lumbar subarachnoid space is first punctured during the insertion of the catheter, care ... Draining and monitoring of cerebrospinal fluid (CSF) flow from the lateral ventricles or lumbar subarachnoid space is indicated ...
Monitoring pressure from the lumbar subarachnoid space can be done only in instances where lumbar puncture does not pose a ... bone and the epidural space; and patients which have demonstrated blockage of cerebrospinal fluid to the subarachnoid space due ... In addition, when the ventricle or lumbar subarachnoid space is first punctured during the insertion of the catheter, care ... Draining and monitoring of CSF flow from the lateral ventricles or lumbar subarachnoid space is indicated in selected patients ...
... and in the anterior epidural space. The largest vascular structures are in the epidural space and the largest of these are ... the frequency of traumatic lumbar puncture was 10.1% for bedside lumbar puncture and 3.5% for fluoroscopy-guided lumbar ... The use of fluoroscopy-guided lumbar puncture could decrease total patient charges. If only the cost of the lumbar puncture is ... However, CSF sampling by lumbar puncture is more sensitive than CT for SAH (1, 2). Unfortunately, traumatic lumbar puncture (ie ...
Spinal injection lumbar epidural simulator disk degeneration training ... Buyamag provide spine models vertebral column puncture study model. ... Lumbar puncture may be performed in the L3-L4, L4-L5, or L5-S1 spaces. The correct site can be located by palpating the iliac ... Lumbar Puncture Includes: the Pediatric Lumbar Puncture Infant on a sturdy board, one lumbar puncture pad with spine and spinal ...
Lumbar Puncture and Spinal Epidural - 17 in. L x 11 in. W x 17 in. H (43 cm x 28 cm x 43 cm), BPLP2101 at Nasco. You will find ... epidural space, and spinal cistern. * Self-healing tissue saves you money by reducing the need for purchasing replacement parts ... Practice a wide variety of procedures including lumbar puncture and lumbar epidural ... Blue Phantom™ Lumbar Puncture and Spinal Epidural - 17 in. L x 11 in. W x 17 in. H (43 cm x 28 cm x 43 cm). ...
Various aspects of both epidural and lumbar puncture insertions were scored for likeness to a real patient using a Likert scale ... Methods: Experienced anesthetists performed an epidural followed by a lumbar puncture procedure on the simulator model. ... Evaluation of a new training device to simulate the epidural and subarachnoid spaces for neuraxial anesthesia techniques. ... Background: We are introducing a new epidural/spinal simulation unit to be used either as a part-task trainer to teach and ...
... lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. Discitis following chemonucleolysis (especially ... Inflammation of an intervertebral disk or disk space which may lead to disk erosion. Until recently, discitis has been defined ... Inflammation of an intervertebral disk or disk space which may lead to disk erosion. Until recently, discitis has been defined ... lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. Discitis following chemonucleolysis (especially ...
Rarely, a lumbar puncture or a spinal tap is performed to check if malignant cells are present in the fluid surrounding the ... In this test, the physician inserts a needle into the epidural space at the base of the spine and collects a small amount of ... In this test, the physician inserts a needle into the epidural space at the base of the spine and collects a small amount of ... In rare cases a lumbar puncture (spinal tap) is performed to see if malignant cells are in the fluid that surrounds the brain. ...
Lumbar puncture bypasses the natural defense barrier of central nervous system and therefore carries a risk of transmitting ... There are multiple routes at which bacteria could migrate into the subarachnoid space. ... There are multiple routes at which bacteria could migrate into the subarachnoid space. Lumbar puncture bypasses the natural ... diagnostic lumbar puncture, epidural anesthesia or any procedures to the spinal canal. There are theoretically two routes at ...
Lumbar puncture is carried out under sterile conditions by inserting a needle into the subarachnoid space, usually between the ... Treatment of an identified leak may include injection of a persons blood into the epidural space (an epidural blood patch), ... A lumbar puncture that drains CSF may also be used as part of treatment for some conditions, including idiopathic intracranial ... CSF can leak from the dura as a result of different causes such as physical trauma or a lumbar puncture, or from no known cause ...
... of cerebrospinal fluid from the dural defect into the epidural space that is created by the spinal needle during puncture. ... for lumbar puncture. Diagnosis. Anaesthesia. Myelography. Not applicable to patients only undergoing epidural puncture. ... Lumbar puncture with any atraumatic (pencil point) needle. Lumbar puncture with any conventional needle. Conventional needle. ... lumbar puncture needles instead of conventional lumbar puncture needles reduced the risk of post-dural-puncture headache and of ...
... the epidural space and dura; gluteal fold and a fluid filled compartment for simulated cerebrospinal fluid. The Training ... The ultrasound lumbar puncture and epidural simulator is a trainer that includes the lumbar vertebrae, iliac crest, spinous ... The ultrasound lumbar puncture and epidural simulator is a trainer that includes the lumbar vertebrae, iliac crest, spinous ... Lumbar Puncture/Epidural. *Deluxe Adult Lumbar Puncture & Epidural Training Package. Deluxe Adult Lumbar Puncture & Epidural ...
... lumbar puncture, or epidural anesthesia, caused by a leak of cerebrospinal fluid from the subarachnoid space. Severe spinal ... Key Words: anesthesia, lumbar puncture, myelography, spinal headache. Incidence of postdural puncture headache and backache, ... due to leakage of cerebrospinal fluid from subarachnoid space through the site of the puncture. Synonym(s): post-lumbar ... Synonym(s): post-lumbar puncture syndrome. spinal headache. a severe headache occurring after spinal anesthesia, ...
AnesthesiaSubarachnoidLigamentum flavumAnalgesiaIdentify the epidural spaceAbscessPerform a lumbar punctureHeadacheCausing intracranial hypotensionSpinousAnestheticComplicationsInjectionsPatient'sComplicationMyelographyBlood PatchPlacementTissueRequires a lumbar punctureInsertionIatrogenicDiagnosisIdentification of the epidural spacePatientsInfant lumbar punctureTraumatic lumbar punctureLateralResistanceIntrathecal spaceTechniqueArachnoidIncidenceEnter the epidural spaceInfectionDiagnosticObese
- Spinal anesthesia is commonly used for cesarean section.However, the procedure is still have some adverse events such as high spinal block, nerve injuries or postdural puncture headache (P. (bioportfolio.com)
- Patients who underwent combined spinal-epidural anesthesia and patients without consent were excluded. (clinicaltrials.gov)
- 2. No motor block (Bromage Scale = 0) occurring within 10 minutes after the injection of local anesthetic into the subarachnoid space and performing spinal anesthesia for the second time or conversion from spinal anesthesia to general anesthesia. (clinicaltrials.gov)
- She received combined spinal-epidural anesthesia from anesthesiologist A, and delivered a healthy baby. (cdc.gov)
- To determine whether other cases of health-care--associated bacterial meningitis had occurred, the hospital conducted a 6-month retrospective review among postpartum patients who received combined spinal-epidural anesthesia. (cdc.gov)
- Background: We are introducing a new epidural/spinal simulation unit to be used either as a part-task trainer to teach and learn regional anesthesia techniques or to be inserted in the manikin's back to allow reliable advanced simulation scenarios. (minervamedica.it)
- It can occur in various settings including spinal anesthesia, diagnostic lumbar puncture, epidural anesthesia or any procedures to the spinal canal. (scirp.org)
- a severe headache occurring after spinal anesthesia, lumbar puncture, or epidural anesthesia, caused by a leak of cerebrospinal fluid from the subarachnoid space. (thefreedictionary.com)
- Two conditions are, therefore, absolutely necessary to produce spinal anesthesia: Puncture of the dura mater and subarachnoid injection of an anesthetic agent. (nysora.com)
- Lumbar punctures may also be done to inject medications into the cerebrospinal fluid, particularly for spinal anesthesia or chemotherapy . (bionity.com)
- However, in previous investigations, cases were detected primarily among hospital patients who received spinal anesthesia or epidural anesthesia. (cdc.gov)
- Epidural analgesia (pain relief) is a type of Regional Anesthesia which is commonly used to ease the pain of labor and childbirth but can also be used to provide anesthesia for other types of surgeries. (wikidoc.org)
- A Spanish surgeon named Fidel Pagés Miravé reported the first single-shot thoracolumbar epidural anesthesia in 1921. (wikidoc.org)
- This technique has some similarity to epidural anesthesia, and the two techniques may be easily confused with each other. (wikidoc.org)
- History of epidural anesthesia== * In 1921, a Spanish surgeon named Fidel Pages developed the epidural anesthesia technique, he was the pioneer of lumbar epidural anesthesia. (wikidoc.org)
- Lumbar puncture can also have therapeutic uses, including injection of drugs and anesthesia. (thefreedictionary.com)
- Its application in neuraxial blockade has not yet enjoyed the same popularity, even though spinal and epidural anesthesia are the most widely used regional anesthetic techniques. (asahq.org)
- and second, to propose a systematic approach to ultrasound imaging of the spine in the performance of spinal and epidural anesthesia. (asahq.org)
- Since then, there have been an increasing number of anesthesia-related publications (including a set of National Institute for Health and Clinical Excellence [NICE]) guidelines 19 ) on ultrasound-guided epidural and spinal anesthesia. (asahq.org)
- Inadvertent dural puncture is a risk of epidural anesthesia and occurs when the needle or catheter punctures the dura and arachnoid maters. (clinicaladvisor.com)
- When experts in regional anesthesia were asked regarding the incidence of post dural puncture headache (PDPH), the response was 1% for epidural anesthesia and 1% for spinal anesthesia. (clinicaladvisor.com)
- Inadvertent dural puncture is a risk for any patient receiving epidural anesthesia/analgesia. (clinicaladvisor.com)
- While epidural anesthesia is possible in a patient with scoliosis, the placement of an epidural catheter is technically more difficult and there is a higher incidence of poorly functioning epidural catheters. (clinicaladvisor.com)
- Neuraxial anesthesia is typically not done in these patients because of the concern of accidental dural puncture. (clinicaladvisor.com)
- Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia: A Systematic Review and Meta-Analysis. (semanticscholar.org)
- Lumbar epidural anesthesia is used for alleviating the pain of labor and for surgery. (ubc.ca)
- Epidural catheter can be continued post operatively to continue analgesia while spinal anesthesia is generally a single shot injection. (wikipedia.org)
- Epidural anesthesia can be continued for longer duration during longer surgeries by either giving top ups of local anesthetics or by continuous infusion of local anesthetics by infusion pumps. (wikipedia.org)
- We report a case in which a patient sustained orthopedic surgery under combined spinal and epidural anesthesia complicated by severe and persistent sensorineural hearing loss. (hindawi.com)
- This phenomenon has been reported following spinal anesthesia or lumbar puncture and can be unilateral or bilateral, typically affecting the low frequency range. (hindawi.com)
- Most epidural abscesses occur in patients who have not received neuraxial analgesia/anesthesia. (clinicalpainadvisor.com)
- Only 5.5% of epidural abscesses are thought to be related to epidural anesthesia, and these patients are often elderly and immunocompromised, developing an epidural abscess following prolonged epidural catheterization. (clinicalpainadvisor.com)
- These signs and symptoms have been mistaken for those associated with postdural puncture headache, a more common complication of neuraxial anesthesia. (clinicalpainadvisor.com)
- Spinal anesthesia also called spinal block, subarachnoidal block or intradural block, is a form of regional anesthesia with the injection of a local anesthetic into the subarachnoid space. (narkosguiden.se)
- Lumbar punctures and epidural catheterisations are common procedures used to access the subarachnoid and epidural spaces. (bmj.com)
- 2 A national audit project estimated that over 293 000 epidurals and 325 000 subarachnoid blocks are performed each year in the United Kingdom. (bmj.com)
- The first attempt success was described as identification or subarachnoid space at the first attempt. (clinicaltrials.gov)
- and patients who have demonstrated blockage of cerebrospinal fluid to the subarachnoid space due to trauma, hematoma, fracture or tumor. (medtronic.com)
- Monitoring pressure from the lumbar subarachnoid space can be done only in instances where lumbar puncture does not pose a danger to the patient. (medtronic.com)
- In patients with suspected subarachnoid hemorrhage (SAH) and negative CT findings, the iatrogenic introduction of RBCs into the CSF during lumbar puncture may lead to a misdiagnosis. (ajnr.org)
- Lumbar puncture is the diagnostic procedure of choice in patients with suspected subarachnoid hemorrhage (SAH) but with no evidence of blood on CT scans of the head. (ajnr.org)
- While fluoroscopy is rarely needed to access the subarachnoid space with a spinal needle, it is routinely used for difficult cases in which bedside lumbar puncture has failed. (ajnr.org)
- With fluoroscopy it is almost always possible to access the subarachnoid space with a single pass of the spinal needle, minimizing trauma to paraspinal and epidural tissues. (ajnr.org)
- There are multiple routes at which bacteria could migrate into the subarachnoid space. (scirp.org)
- The CSF occupies the subarachnoid space (between the arachnoid mater and the pia mater) and the ventricular system around and inside the brain and spinal cord. (wikipedia.org)
- There is also a connection from the subarachnoid space to the bony labyrinth of the inner ear via the perilymphatic duct where the perilymph is continuous with the cerebrospinal fluid. (wikipedia.org)
- From the fourth ventricle, the fluid passes into the subarachnoid space through four openings - the central canal of the spinal cord, the median aperture, and the two lateral apertures. (wikipedia.org)
- CSF is present within the subarachnoid space, which covers the brain, spinal cord, and stretches below the end of the spinal cord to the sacrum. (wikipedia.org)
- CSF moves in a single outward direction from the ventricles, but multidirectionally in the subarachnoid space. (wikipedia.org)
- due to leakage of cerebrospinal fluid from subarachnoid space through the site of the puncture. (thefreedictionary.com)
- Then, the needle must pass through the epidural space, dura mater, arachnoid mater, and enter the subarachnoid space. (brainscape.com)
- Inability to reach the subarachnoid space, errors in drug preparation or injection, the unsatisfactory spread of the injectate within the cerebrospinal fluid (CSF), ineffective drug action on neural tissue, and difficulties relating to patient expectations and psychology rather than genuine block failure. (nysora.com)
- The anatomy is usually straightforward to palpate and identify, the technique for needle insertion simple and easy to teach, and the presence of CSF acts as both a definite endpoint for needling and a medium for carriage of local anesthetic within the subarachnoid space. (nysora.com)
- The most evident cause of failure is an inability to successfully access the subarachnoid space. (nysora.com)
- Issues with equipment may result in a lack of CSF flow despite the correct placement of the needle within the subarachnoid space. (nysora.com)
- Aims o To measure CSF pressure in the subarachnoid space. (scribd.com)
- Visualization time for 5 anatomical structures (spinous processes or laminae, ligamentum flavum, dura mater, epidural space,subarachnoid space), body mass index, and perception of landmark palpation difficulty were recorded. (bestbets.org)
- Cerebrospinal fluid (CSF) circulates in the subarachnoid space and has a twofold function: to protect the brain and spinal cord from injury and to transport products of cellular metabolism and neurosecretion. (thefreedictionary.com)
- Such bleeds are more common in the elderly and in infants because of their larger subarachnoid space, which permits more movement between the brain and dura, predisposing these age groups to the formation of subdural haematomas (SDH). (ndtv.com)
- An anesthetic agent is injected into the subarachnoid space surrounding the spinal cord. (nursingcrib.com)
- The distal ends are adapted for insertion into the subarachnoid space. (google.com)
- The cerebrospinal fluid circulates in the subarachnoid space around the brain and spinal cord , and in the ventricles of the brain. (wikipedia.org)
- LP should not be performed through infected skin as organisms can be introduced into the subarachnoid space (SAS). (mhmedical.com)
- A subarachnoid haemorrhage is bleeding into the subarachnoid space - the area between the arachnoid membrane and the pia mater surrounding the brain. (medicalnegligence-claims.org)
- Its primary role is to maintain the cerebrospinal fluid that fills the subarachnoid space between the pia and the arachnoid. (elpasobackclinic.com)
- To see how the fluid is moving diagnostic images are done by injecting dye know as myelography or radioactive substances known as cisternography into the subarachnoid space before imaging. (elpasobackclinic.com)
- The lumbar puncture procedure allows the user to penetrate the subarachnoid space and CSF is present when the stylet is removed. (emdservices.com)
- When spontaneous backflow of CSF was observed, intrathecal 12.5 mg of heavy bupivacaine with 15 μ g fentanyl was injected into his subarachnoid space. (hindawi.com)
- Extremely realistic anatomy allows clinicians to access the epidural or subarachnoid space while utilizing blind insertion or ultrasound guided lumbar puncture and lumbar epidural procedural techniques. (bluephantom.com)
- The lumbar puncture and lumbar epidural replacement tissue module is superb in its realism and contains comprehensive anatomical structures, including skin tissue, lumbar spine, dura, epidural space, ligamentum flavum, subarachnoid membrane, subarachnoid cistern, and cerebral spinal fluid (CSF). (bluephantom.com)
- Our realism allows for full procedural training, including injecting local anesthetics, accessing the epidural and/or subarachnoid space (spinal taps or punctures), threading catheters, infusing anesthetics, and collecting manometer readings. (bluephantom.com)
- Leptomeningeal metastasis is defined as the spread of tumour cells within the leptomeninges and the subarachnoid space. (bmj.com)
- Between the arachnoid and pia mater is the subarachnoid space that is filled out with CSF. (antranik.org)
- A very rare complication following a lumbar puncture is creation of an iatrogenic multi space, leading to spinal hemorrhage in either the epidural, subdural or subarachnoid spaces. (sajem.org)
- A lumbar puncture (LP) is often performed to check for the presence of bacterial, viral and fungal infections, excessive intracranial pressure, a cerebrospinal fluid (CSF) leak, cancers of the brain or spine, subarachnoid hemorrhage (bleeding on the brain), or to aid in the diagnosis of other neurological conditions such as Guillain-Barre syndrome and multiple sclerosis or a mitochondrial disease. (zebrapit.com)
- Ligamentum flavum midline gaps are thought to be a potential cause of failed recognition of loss of resistance during epidural needle placement and consequently accidental dural puncture. (bioportfolio.com)
- Therefore, if it were feasible to avoid inserting the epidural needle at the same level where a ligamentum flavum midline gap exists, then dural punctures may be less likely. (bioportfolio.com)
- Lumbar spine ultrasound has been very useful in consistently identifying important anatomical landmarks for epidural needle placement including the ligamentum flavum. (bioportfolio.com)
- Our objective is to determine whether or not there is a correlation between accidental dural punctures and abnormalities of ligamentum flavum as seen by ultrasound imaging. (bioportfolio.com)
- Our hypothesis is that patients who have had accidental dural punctures have abnormal anatomy of ligamentum flavum that can be detected by lumbar spine ultrasound. (bioportfolio.com)
- Incidence of abnormal ligamentum flavum and asymmetry will be presented in a descriptive way and the level of anatomical abnormality detected by ultrasound will be correlated to the level of dural puncture reported on the anaesthesia record. (bioportfolio.com)
- 12 We therefore designed a method of epidural catheter placement using a technique that would specifically identify the ligamentum flavum and the dura. (asahq.org)
- The loss of resistance technique (LORT) [ 1 ] for identifying the epidural space was originally described by Dogliotti in 1933, using saline as a medium and was based on the different densities of tissues encountered as the needle tip passed through the ligamentum flavum into the epidural space. (hindawi.com)
- When performing an epidural injection, the following structures are sequentially pierced: the skin, the supraspinous and interspinous ligaments, and then the thick fibrous-elastic ligamentum flavum. (hindawi.com)
- This novel method is tested on ultrasounds of the lumbar anatomy in 20 human subjects and shows the method successfully detects the ligamentum flavum in 34 of 39 cases. (ubc.ca)
- Using Blue Phantom patented tissue technology, the LP replacement module allows users to experience an exceptionally realistic tissue response, including the "pop" when crossing the ligamentum flavum, loss of resistance while entering the epidural space, and CSF flow when the user successfully gains access to the spinal cistern. (bluephantom.com)
- 1 Epidural catheterisations provide regional anaesthesia and analgesia during childbirth or surgical procedures. (bmj.com)
- Accidental dural puncture is a potential complication of epidural analgesia for labour and delivery. (bioportfolio.com)
- Lumbar epidurals (LEs) provide excellent analgesia. (ovid.com)
- Combined spinal epidural and dural puncture epidural (DPE) are 2 techniques to expedite neuraxial analgesia onset. (ovid.com)
- The primary goal of this study was to compare the percentage of patients who achieved adequate labor analgesia following DPE or LE with an epidural bolus of 0.125% bupivacaine. (ovid.com)
- Adequate labor analgesia was defined as Visual Analog Scale (VAS) measurement ≤ 10 mm on a 100-mm scale during active contractions, measured 10 minutes after epidural bolus initiation. (ovid.com)
- Although the percentage of parturients achieving adequate labor analgesia at 10 minutes after epidural bolus did not differ by technique, DPE was associated with faster time to VAS ≤ 10 mm compared with LE. (ovid.com)
- 3,4 Between 2001 and 2004, Grau and colleagues conducted a series of investigations that demonstrated the utility of ultrasound in epidural analgesia and were pivotal in improving our understanding of spinal sonography. (asahq.org)
- 1-3 However, up to 10% of epidurals fail to provide adequate analgesia because of incorrect catheter placement using the LOR technique. (asahq.org)
- We performed epidural block with the CompuFlo® epidural instrument in 120 healthy women who requested labor epidural analgesia. (hindawi.com)
- In this retrospective study, postoperative pain score, epidural patient controlled analgesia (Epi-PCA) related complications, the risk factors for requirement of rescue analgesics and anti. (bioportfolio.com)
- Epidural Analgesia and Subcutaneous Heparin 3 Times Daily in Cancer Patients With Acute Postoperative Pain. (bioportfolio.com)
- The use of epidural analgesia in conjunction with subcutaneous administration of unfractionated heparin 3 times per day could increase the risk of spinal epidural hematoma, but insufficient patient ex. (bioportfolio.com)
- Seventy-five patients requesting extradural analgesia for the relief of pain in labour underwent an ultrasound scan to measure the depth to the extradural space. (semanticscholar.org)
- Techniques such as epidural analgesia and epidural anaesthesia employ this route of administration. (wikipedia.org)
- To achieve epidural analgesia or anaesthesia, a larger dose of drug is typically necessary than with spinal analgesia or anaesthesia. (wikipedia.org)
- The onset of analgesia is slower with epidural analgesia or anaesthesia than with spinal analgesia or anaesthesia. (wikipedia.org)
- It is easier to achieve segmental analgesia or anaesthesia using the epidural route than using the spinal route. (wikipedia.org)
- An indwelling catheter is more commonly placed in the setting of epidural analgesia or anaesthesia than with spinal analgesia or anaesthesia. (wikipedia.org)
- Injecting medication into the epidural space is primarily performed for analgesia. (wikipedia.org)
- Additionally, some of the side-effects of epidural analgesia may be beneficial in some circumstances (e.g., vasodilation may be beneficial if the subject has peripheral vascular disease ). (wikipedia.org)
- The anaesthetist may use epidural analgesia in addition to general anaesthesia. (wikipedia.org)
- For post-operative analgesia, after an operation where the epidural technique is employed as the sole anaesthetic, or in conjunction with general anaesthesia. (wikipedia.org)
- The caudal epidural infiltration is currently one of the regional analgesia techniques that are most frequently used for chronic low back pain . (backpaindoctor.co.uk)
- When a catheter is placed into the epidural space (see below), the effects of the analgesia may be prolonged for several days, if required. (bionity.com)
- Through the use of a patient-controlled analgesia (PCA) infusion pump, a patient may be given the ability to control post-surgical pain medications administered through the epidural. (bionity.com)
- Because of the nature of epidurals, they are most suitable for analgesia for the abdomen, pelvis or legs. (bionity.com)
- if the patient were septic, the patient would be at risk for the development of an epidural abscess. (clinicaladvisor.com)
- Spinal epidural abscess is a suppurative infection of the central nervous system. (statpearls.com)
- Although classically patients with spinal epidural abscess present with midline back pain, fever, and neurologic deficits, presentations of this disease process can be variable. (statpearls.com)
- Spinal epidural abscess is difficult to diagnose if clinical suspicion is not high. (statpearls.com)
- When left untreated spinal epidural abscess can cause significant morbidity and mortality. (statpearls.com)
- In patients presenting with spinal epidural abscess, bacteria enter the epidural space resulting in a suppurative infection. (statpearls.com)
- Diabetes mellitus is the most common risk factor associated with spinal epidural abscess although intravenous drug use and epidural catheter placement are becoming increasingly important risk factors in the development of this disease process. (statpearls.com)
- Spinal epidural abscess is an uncommon diagnosis. (statpearls.com)
- Although spinal epidural abscess is uncommon, its incidence has been increasing in recent years. (statpearls.com)
- In one-third of cases of spinal epidural abscess, there is no identifiable nidus of infection. (statpearls.com)
- Diabetes mellitus is the greatest risk factor for a spinal epidural abscess. (statpearls.com)
- In total, 33% of patients presenting with spinal epidural abscess have diabetes mellitus. (statpearls.com)
- Other important risk factors for the development of spinal epidural abscess include intravenous drug use and instrumentation of the epidural space. (statpearls.com)
- In intravenous drug use, hematogenous seeding of the epidural space occurs which leads to spinal epidural abscess. (statpearls.com)
- Staphylococcus aureus accounts for 63% of spinal epidural abscess infections, followed by gram-negative bacilli (16%), streptococcal infections (9%), and other bacteria/mycobacteria/fungi accounting for ~10% of infections. (statpearls.com)
- This occurs when psoas abscess, vertebral osteomyelitis, or discitis leads to a spinal epidural abscess. (statpearls.com)
- Additionally, a spinal epidural abscess can be the result of the direct inoculation of this tissue. (statpearls.com)
- Epidural injections, epidural catheter placements, lumbar punctures, and other central nervous system (CNS) procedures all can result in epidural abscess through direct inoculation. (statpearls.com)
- Infection also can be the result of the contiguous spread of a disease such as vertebral osteomyelitis, discitis, retropharyngeal abscess, retroperitoneal abscess, or through penetrating injury, epidural injection or catheter placement, lumbar puncture, or recent CNS surgery. (statpearls.com)
- Once bacteria have gained entrance into the epidural space, a resulting pyogenic infection occurs, which then results in abscess formation. (statpearls.com)
- Typically, the spinal epidural abscess will involve 3 to 5 spinal cord segments. (statpearls.com)
- The classic triad of a spinal epidural abscess is back pain (75%), fever (48%), and neurologic deficits (33%) due to the direct compressive effects of the abscess. (statpearls.com)
- If secondary to sinusitis or otitis media, the symptoms such as nasal congestion or ear pain may even be more prominent than the dull headache of the cranial epidural abscess. (oncologynurseadvisor.com)
- While fever and headache are usually present, patients may often feel well enough to delay seeking medical attention until the epidural abscess has become complicated by subdural empyema, brain abscess, or meningitis. (oncologynurseadvisor.com)
- If left untreated with an enlarging abscess confined to the epidural space, a significant amount of mass effect may produce papilledema or other signs of increased intracranial pressure. (oncologynurseadvisor.com)
- Uniquely, if an epidural abscess is present near the petrous bone, Gradenigo syndrome may be present with unilateral facial pain, weakness of the lateral rectus muscle, and palsy of cranial nerves V and VI. (oncologynurseadvisor.com)
- Infection (epidural abscess) is exceptional. (backpaindoctor.co.uk)
- Meningitis and epidural abscess are two serious infections associated with neuraxial techniques. (clinicalpainadvisor.com)
- In cases with suspected raised intracranial pressure or epidural abscess, an MRI or CT scan is safer. (clinicalpainadvisor.com)
- The purpose of this study is to determine the effect of 19g versus =>18g traditional Tuohy-type epidural needles on the incidence and severity of postdural puncture headache (PDPH). (bioportfolio.com)
- It is also postulated that the relief of the headache after an epidural blood patch is due to more of a compression effect than sealing the leak. (wikipedia.org)
- Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache. (thisisms.com)
- After the lumbar puncture the patient's headache seemed better when she was lying down but would get worse when she sat up or tried to walk. (pediatriceducation.org)
- The diagnosis of a post-dural puncture headache was made. (pediatriceducation.org)
- Post-dural puncture headache or spinal headache as they are often called, are headaches that occur within 7 days of a lumbar puncture and remit within 14 days of the lumbar puncture. (pediatriceducation.org)
- Most spinal headaches occur within 1-2 days of the lumbar puncture and spontaneously resolve after 5 days of headache (range 1-12 days). (pediatriceducation.org)
- Not all patients who have an inadvertent dural puncture develop a headache. (clinicaladvisor.com)
- Post-dural puncture headache is a well-known clinical complication of intrathecal space instrumentation. (epostersonline.com)
- A Complex Presentation of Headache after Lumbar. (epostersonline.com)
- The injection of autologous blood into the epidural space either as a prophylactic treatment immediately following an epidural puncture or for treatment of headache as a result of an epidural puncture. (bioportfolio.com)
- Accidental puncture of the dura that occurs with headache and leakage of the cerebrospinal fluid that disappears in a lying position. (backpaindoctor.co.uk)
- We also analyzed occurrence of early bladder filling and post-lumbar puncture headache. (biomedcentral.com)
- The 22 G and 23 G groups had a higher but non-significant incidence of post lumbar headache. (biomedcentral.com)
- We also recorded early bladder filling and analyzed the occurrence of post-lumbar headache (PLH) in the same groups. (biomedcentral.com)
- In this article, we use the terms "interlaminar space" and "interspinous space" to refer to the gaps between adjacent laminae and spinous processes, respectively. (asahq.org)
- 7.4, the supericial ring envelop the erector spinae muscles) chapter 4 back 23 5 clinical focus 3-7 lumbar puncture cauda epidural equina space spinous process of middle finger against resistance compression by visceral, retroperitoneal, and renal bone disease. (puc.edu)
- In sequence, these phases are lumbar puncture, injection of local anesthetic solution, spread of solution through the CSF, drug action on neural tissue, and patient management. (nysora.com)
- An epidural anesthetic is delivered into the extradural space, a catheter is left in situ to provide long-term pain relief postoperatively. (passmyclinicalexamination.com)
- Medline and Embase was searched for the period of 1966 to 2006 using the following key words: lumbar, injections, steroids, epidural, sciatica, dural punctures, and complications. (practicalpainmanagement.com)
- Once the almost exclusive sequelae of sinusitis, otitis media, or mastoiditis, cranial epidural abscesses are now often secondary to neurosurgical complications. (oncologynurseadvisor.com)
- Spinal produces less puncture complications than epidural. (narkosguiden.se)
- This case is important as multiple attempts of lumbar puncture, whether to obtain a spinal tap or CT Myelogram, could lead to complications such as the ones our patient faced. (sajem.org)
- Epidural steroid injections are a routine treatment for low back pain despite the potential of dural puncture. (practicalpainmanagement.com)
- Current opinion is mixed about the necessity of using fluoroscopy when performing epidural injections. (practicalpainmanagement.com)
- To our knowledge, no studies have addressed the number of dural punctures acquired when performing fluoroscopic-guided lumbar epidural injections. (practicalpainmanagement.com)
- The intent of this study was to determine if the use of fluoroscopy reduces the number of dural punctures during epidural lumbar injections and thereby increases the safety of epidural injections. (practicalpainmanagement.com)
- This retrospective study compared the number of dural punctures observed in 500 fluoroscopically-guided lumbar epidural injections to the number reported in literature for non-fluoroscopically-guided lumbar procedures. (practicalpainmanagement.com)
- Another standard practice of traditional medicine is epidural steroid injections. (caringmedical.com)
- Data were collected retrospectively from two populations: adult inpatients undergoing standard bedside lumbar puncture for any reason and adult patients undergoing fluoroscopy-guided lumbar puncture for myelography. (ajnr.org)
- Data were collected retrospectively for a 3-year period at our hospital from two populations: adult inpatients undergoing standard bedside lumbar puncture for any reason and adult patients undergoing fluoroscopic lumbar puncture for myelography. (ajnr.org)
- In this study, we present our experience with the administration of a large-volume blood patch to multiple sites in the epidural space through a single-catheter access site. (ajnr.org)
- and 80% of patients who had a previously failed site-directed epidural blood or fibrin glue patch improved with a large volume catheter-directed blood patch. (ajnr.org)
- Administration of a large-volume blood patch at multiple sites in the epidural space is a recently reported novel technique for the treatment of SIH. (ajnr.org)
- An epidural blood patch may also be attempted where ~10-15 ml of autologous blood is placed into the epidural space as close as possible to the lumbar puncture site. (pediatriceducation.org)
- However, if no leak is identified then a general epidural blood patch is the choice treatment. (cedars-sinai.edu)
- Various modalities have been proffered for treatment of PDPH, however epidural blood patch remains the gold-standard therapy. (epostersonline.com)
- An epidural blood patch is used in the treatment of intracranial hypotension arising spontaneously or occurring after lumbar puncture. (acpinternist.org)
- During his residency, Dr. Tsui developed an interest in improving the accuracy of epidural catheter placement and was issued a U.S. patent in relation to his research. (stanford.edu)
- Immediately before epidural placement, subjects marked a VAS score during an active contraction and parturients with VAS (ovid.com)
- 12 Therefore, epidural failure using sonographic-assisted neuraxial placement is still reported. (asahq.org)
- Instrumentation of the epidural space occurring during lumbar puncture or epidural catheter placement can directly inoculate bacteria into the epidural space causing this infectious process. (statpearls.com)
- Allows surgical placement of chest tubes to treat pleural effusion by draining fluids from the pleural space. (nysimcenter.org)
- The presence of brain atrophy or loss of brain tissue due to any cause, such as old age, alcoholism, or stroke, provides a potential space between the dura and the brain surface. (ndtv.com)
- Bacteria also can enter the epidural space through the direct extension of infected tissue. (statpearls.com)
- Each tissue includes a spinal cord filled with simulated CSF and the epidural venous plexus filled with simulated blood providing the user with both a positive or negative response. (emdservices.com)
- Blue Phantom lumbar puncture and lumbar epidural ultra-durable replacement tissue. (bluephantom.com)
- Blue Phantom lumbar puncture and lumbar epidural replacement tissue is for use with our Spinal Epidural and Lumbar Puncture training models (P/N BPLP2101). (bluephantom.com)
- The lumbar puncture and lumbar epidural tissue insert is constructed using Blue Phantom self-healing and ultra-durable tissue. (bluephantom.com)
- For instance, most experts agree that any infant less than 2 months of age with fever of 38 degrees Celsius (100.4 degrees Fahrenheit) or greater and no identifiable source requires a lumbar puncture. (bionity.com)
- It requires a lumbar puncture through one of the interspaces between lumbar disc 2 (L2) and the sacrum (S1). (nursingcrib.com)
- Results: Experienced anesthetists found the simulator to be life-like for almost all the aspects of epidural or spinal insertion and that the overall impression was that the simulator could provide a useful tool for training of epidural and spinal techniques. (minervamedica.it)
- An epidural catheter after insertion. (wikidoc.org)
- Additionally in iatrogenic cases, the leakage may be refractory to small-volume single-site injection of epidural blood. (ajnr.org)
- Iatrogenic meningitis is also known as "postdural puncture meningitis" because of its close temporal association with dural puncture. (clinicalpainadvisor.com)
- We report a case of iatrogenic multi spacing following a failed lumbar puncture to obtain a CT Myelogram. (sajem.org)
- Khan HM, Naveed N, Khan H. Iatrogenic Multi Spaces, Spinal Hemorrhage after Lumbar Puncture. (sajem.org)
- Indications The utility of lumbar puncture (LP) has been superceded by CT and MRI in the diagnosis of most intracranial mass lesions but diagnostic LP is still useful in the following conditions: o o o o o o o CNS infection (bacterial, viral, fungal, protozoan). (scribd.com)
- Given that spinal epidural abscesses most commonly are caused by hematogenous spread, 9% of patients presenting with this diagnosis will have two or more noncontiguous areas of pyogenic collections. (statpearls.com)
- Generally, the goal of imaging is confirmation of the diagnosis of SIH through the visualization of a leak, as well as localization of the leak, to facilitate targeted treatment with either epidural patching or surgery. (medscape.com)
- Documentation of an elevated CSF opening pressure without evidence of a space-occupying lesion on neuroimaging confirms the diagnosis of idiopathic intracranial hypertension (IIH). (acpinternist.org)
- ultrasound on the patients who have had accidental dural punctures and analyze if there is any abnormal anatomy seen. (bioportfolio.com)
- Our study will evaluate by ultrasound scan the lumbar vertebral column of patients who have had a previously recognized accidental dural puncture. (bioportfolio.com)
- A range of interchangeable puncture blocks is supplied to simulate elderly and obese patients. (limbsandthings.com)
- The use of fluoroscopy-guided lumbar puncture in patients with suspected SAH and negative CT findings should reduce the frequency of false-positive diagnoses of acute SAH as well as the number of unnecessary angiograms for patients with suspected SAH but no underlying intracranial vascular malformation. (ajnr.org)
- Lumbar puncture has been supplanted by CT as the primary diagnostic technique in patients with suspected SAH, because lumbar puncture provides no information about the degree and location of SAH or the sequela of hemorrhage in the cerebral parenchyma. (ajnr.org)
- Because SAH often reflects the presence of aneurysms or other cerebral vascular malformations, patients with a positive lumbar puncture usually undergo one or even two diagnostic cerebral angiograms. (ajnr.org)
- After a bolus lumbar injection of 50 or 100 mcg Lioresal Intrathecal in seven patients, the average CSF elimination half-life was 1.51 hours over the first four hours and the average CSF clearance was approximately 30 mL/hour. (drugs.com)
- A total of 97 patients with lumbar disc herniation treated in our hospital from January 2017 to August 2017 were selected as the research objects followed by being randomly divided into microendoscopy discectomy group (n=43) and open surgery group (n=44) with the method of drawing lots in which the open surgery group were given open surgery while the discectomy group received posterior microendoscopy discectomy (MED) treatment. (alliedacademies.org)
- In this research, we selected 97 patients with lumbar disc herniation who were treated in our hospital from January 2017 to 2017 August to deeply study clinical effects of MED treatment and open surgery on lumbar disc herniation. (alliedacademies.org)
- The main indication is irradiated low back pain to lower limbs linked to the narrow lumbar canal, to discopathies and to patients with postoperative fibrosis. (backpaindoctor.co.uk)
- In patients undergoing treatment with anticoagulant and/or platelet antiaggregants, the pre-puncture treatment must be modified. (backpaindoctor.co.uk)
- We tested the hypothesis that the risk of traumatic lumbar puncture is lower with the fluoroscopy-guided technique than with the standard bedside technique. (ajnr.org)
- Using a cutoff of 1000 cells/mm 3 , the frequency of traumatic lumbar puncture was 10.1% for bedside lumbar puncture and 3.5% for fluoroscopy-guided lumbar puncture. (ajnr.org)
- Therefore, any means of decreasing the rate of traumatic lumbar puncture would decrease the morbidity, discomfort, and cost associated with the evaluation of suspected SAH. (ajnr.org)
- Fluoroscopic guidance has the potential to decrease the frequency of traumatic lumbar puncture. (ajnr.org)
- In performing a lumbar puncture, first the patient is usually placed in a left (or right) lateral position with his/her neck bent in full flexion and knees bent in full flexion up to his/her chest, approximating a fetal position as much as possible. (bionity.com)
- Lumbar puncture may be undertaken with the subject sitting or lying in the left lateral position ( figure 53a,b ). (passmyclinicalexamination.com)
- Although this technique has a high success rate, it is associated with a significant incidence of accidental dural punctures. (bioportfolio.com)
- p.78: Perform a successful lumbar puncture when indicated with minimal discomfort to patient observing full aseptic technique. (limbsandthings.com)
- A lumbar puncture requires aseptic technique (sterile) and performance by qualified and skilled medical practitioners. (bionity.com)
- Epidural is a technique for perioperative pain management with different applications in anesthesiology and it can be a single shot or a continuous infusion for long term pain relief. (wikidoc.org)
- There also has been interest in the use of the technique by emergency physicians to guide lumbar puncture. (asahq.org)
- Some operations, most frequently Caesarean section , may be performed using an epidural anaesthetic as the sole technique. (wikipedia.org)
- The sacrococcygeal pathway is the simplest and the least complicated epidural infiltration technique. (backpaindoctor.co.uk)
- The technique involves puncturing the sacrococcygeal hiatus to access the lumbar epidural space. (backpaindoctor.co.uk)
- Intracranial and lumbar pressure monitoring has been associated with intracranial infection, meningitis and ventriculitis. (medtronic.com)
- Lumbar puncture bypasses the natural defense barrier of central nervous system and therefore carries a risk of transmitting infection to the meninges. (scirp.org)
- Contraindications o Skin infection at puncture site. (scribd.com)
- This introduction of bacteria into this normally sterile space results in a suppurative infection within this confined area. (statpearls.com)
- They occur spontaneously in the general population due to hematological spread of a remote focus of infection to the epidural space. (clinicalpainadvisor.com)