Body position and eerebrospinal fluid pressure. Part 2' Clinical studies on orthostatic pressure and the hydrostatic indifferent point

Size: px
Start display at page:

Download "Body position and eerebrospinal fluid pressure. Part 2' Clinical studies on orthostatic pressure and the hydrostatic indifferent point"

Transcription

1 Body position and eerebrospinal fluid pressure Part 2' Clinical studies on orthostatic pressure and the hydrostatic indifferent point BJORN MAGNAES, M.D. Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway v" Lumbar cerebrospinal fluid (CSF) pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. The level of zero CSF pressure while in the sitting position (ZPS) and hydrostatic indifferent point (HIP) for lateral and sitting positions were determined and referred to the craniospinal axis. In control patients ZPS was located mainly at the upper cervical region, and showed nearly the same variation and frequency distribution as CSF pressure in the lateral position when efforts were made to reduce sources of error and there was no orthostatic change in CSF filling pressure. Under these circumstances ZPS may be used as a variable comparable from one subject to another. In control patients the HIP was located between C-6 and T-5. In 25 hydrocephalic patients, shunting resulted in a mean caudal shift of ZPS of 244 mm, and a mean pressure fall of 126 mm H20 in the lateral position. This difference was due to a caudal shift of HIP on shunting. A caudally located ZPS was found in patients with complete cervical subarachnoid block. Prevention and treatment of CSF leakage cranial to HIP is discussed. KEY WORDS 9 postural changes 9 cerebrospinal fluid pressure 9 orthostatic pressure 9 hydrostatic indifferent point T HE recognition of complications due to lowered cerebrospinal fluid (CSF) pressure secondary to CSF shunting has led to an increasing interest in recording the ventricular CSF pressure in the erect body position? '6 Recording of lumbar CSF pressure in the sitting position has not been of great value in clinical practice. The reason for this may be 1) problems in reproducing identical and stable conditions for the pressure recording, 2) difficulty in defining a valid zero reference level, and 3) a varying hydrostatic pressure component due to differences in body length. Yet, the level of zero CSF pressure with the patient in the sitting position (ZPS) has been of some interest? When the body is tilted from the lateral to the sitting position, the pressure in the lower part of the body rises while the pressure in the upper part falls. There must obviously exist a transition zone where the fluid pressure is equal in the lateral and sitting positions. This so-called hydrostatic indifferent point (HIP) has been determined for the venous and 698 J. Neurosurg. / Volume 44 / June, 1976

2 Body position and CSF statics arterial system and has been stated to represent a useful reference point of postural pressure changes? There seems to be no report on the HIP in the CSF space. This paper deals with the ZPS and the HIP for lateral and sitting positions determined by lumbar CSF pressure recording. Emphasis was placed on evaluating these variables for clinical neurosurgery. Clinical Material and Methods Clinical Material The lumbar CSF pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. Group 1: Control. The control group consisted of 72 patients with neck and arm pains due to cervical spondylosis. A spinal subarachnoid block test was performed on these patients. All patients had normal CSF protein and no hindrance to CSF flow on jugular compression. In these patients, the distance from the occipital protuberance to C-7 was also measured to compare the variation in ZPS with the variation in CSF pressure in the lateral position. Group 2." Hydrocephalus. This group comprised 25 patients with hydrocephalus of whom seven had noncommunicating hydrocephalus. The CSF pressure was recorded before and after ventriculoatrial shunting with a Pudenz medium pressure system. These were selected patients in whom a functioning shunt could be determined fairly accurately by their clinical improvement. The shunts were tested before insertion by measuring opening and closing pressure. Three of these patients had a continuous intraarterial blood pressure recording. Group 3." CSF Leakage. The CSF pressure was recorded during a period of CSF leakage and at a later stage with no leakage in four patients with CSF rhinorrhea and two patients with CSF leakage after neck surgery. Group 4." Skull Defect. In five patients with large, flaccid skull defects the CSF pressure was recorded before and after cranioplasty. Group 5." Cervical Block. In eight patients with complete subarachnoid block due to cervical spondylosis the CSF pressure was recorded before and after decompressive laminectomy resulting in a normal square wave response on jugular compression. Group 6." One-Hour Recording. In 10 control patients and five hydrocephalic patients who were judged to have a high degree of mental and cardiovascular stability, the pressure recording in the sitting position was extended to a period of 1 hour. Pressure Recording and Tilting Procedure The lumbar CSF pressure and arterial blood pressure were recorded and the tilting performed as described? In patients with skull defects lying in the lateral position, the CSF pressure was given as the mean of the pressure recorded in the right and left lateral position. During the 1- hour pressure recording in the sitting position, the Group 6 patients were slightly supported and constantly reminded to keep erect and relaxed, and to keep their eyes fixed on a target placed level with their heads. Determination of ZPS and HIP The CSF pressure in the sitting position was read in millimeters of water, measured vertically from the transducer along the body axis and referred to the spinous process of a vertebra or to the head. The spinous process was identified by palpation. This reference point was the ZPS, or the level of zero CSF pressure in the sitting position. At this point the CSF pressure is equal to atmospheric pressure. Cranial to the ZPS the CSF pressure is negative. From the ZPS the CSF pressure recorded in the lateral position was measured caudally to find the HIP as shown in Fig. 1. At this point the CSF pressure would be equal in the lateral and sitting positions, and this is the HIP for the lateral and sitting positions. Pressure Fall on CSF Shunting The pressure fall in the lateral position was recorded in the usual way with the mid-spine as zero reference level. The pressure fall with the patient in the sitting position was recorded as the distance between the ZPS before and after shunting. Results Lateral to Sitting Position When changing to the sitting position, 112 patients had either a transient or no change in the filling pressure, while four hydrocephalic J. Neurosurg. / Volume 44 / June,

3 B. Magnaes FIG. 1. Drawing shows that the distance between ZPS and HIP corresponds to the CSF pressure in the lateral position (mm H20). ZPS = Level of zero CSF pressure while in the sitting position. HIP = Hydrostatic indifferent point for lateral and sitting positions. patients had a stationary increased filling pressure in the sitting position? In these four patients the primary pressure rise was used when determining the ZPS and HIP. In 108 patients the pressure level at 5 minutes after changing was remarkably stable and was used for determining the ZPS and HIP (Fig. 2 left). Three hydrocephalic patients and one control patient felt faint in the sitting position and had a fall in CSF pressure. The tracing from one of the hydrocephalic patients who also had an intraarterial blood pressure recording running is shown in Fig. 2 right. In these four patients the first stable part of the tracing was used in determining the ZPS and HIP. ZPS and HIP Group 1: Control. The CSF pressure in the sitting position ranged from 320 to 630 mm H~O, with a mean pressure of 490 mm H20. This wide range of CSF pressure was markedly narrowed when recorded at the ZPS, which was usually located at the level of the cervical spine with the corresponding HIP's at the level of the upper thoracic spine (Fig. 3). The ZPS and the CSF pressure FIG. 2. Left: Typical stable CSF pressure level while in the sitting position. Right: Orthostatic intolerance. Fainting symptoms and unstable CSF pressure level while in the sitting position, concomitant with a fall in arterial blood pressure (BP). 700 J. Neurosurg. / Volume 44 /June, 1976

4 Body position and CSI ~" statics recorded in the lateral position are compared in Fig. 4. All except four patients had the ZPS located by reference to the occipital protuberance and to C-7, a mean distance of 140 mm in the 72 control patients. The CSF pressure in patients in the lateral position varied within 130 mm H20, ranging from 50 to 180 mm H20. Group 2." Hydrocephalus. In these patients the ZPS before shunting was at or above the level of the cervical spine, while after shunting, between the levels of T-2 and T-9. Shunt- FIG. 3. Frequency distribution of ZPS and HIP referred to craniospinal axis in 72 control patients. The star (,) = the occipital protuberance. Fie. 5. Measurements of caudal shift of ZPS and HIP in 25 hydrocephalic patients on CSF shunting. The star (,)= the occipital protuberance. FIG. 4. Measurements in the 72 control patients. Upper: Variation in ZPS and CSF pressure in the lateral position. Distance from occipital protuberance (OP) to C-7 was 140 mm. Lower. Frequency distribution of CSF pressure in the lateral position. FIG. 6. Graph showing CSF shunting resulting in a larger pressure fall in the sitting than in the lateral position. The difference was due to a caudal shift of HIP on shunting. Broken line indicates line of identity (equal pressure fall in lateral and sitting position). J. Neurosurg. / Volume 44 / June,

5 B. Magnaes FIG. 7. Measurements in patients with CSF leakage indicate that the ZPS and HIP shifted caudally. The star (*) = the occipital protuberance. FIG. 8. Measurements in patients with large, flaccid skull defects show that the ZPS and HIP shifted cranially. The star (,) = the occipital protuberance. ing also resulted in a marked caudal shift of the HIP to below the HIP's in the control group (Fig. 5). The pressure fall on shunting was larger when measured in the sitting position than in the lateral position. The mean pressure fall in the lateral position was 126 mm H20 compared with 244 mm H20 in the sitting position (Fig. 6). Group 3: CSF Leakage. During periods of verified CSF leakage the ZPS and HIP were found caudally displaced compared with the levels at a later stage with no leakage. The ZPS and HIP were then within the levels found in the control group (Fig. 7). Group 4: Skull Defect. In the five patients with skull defects, the ZPS and HIP were cranially shifted, while after cranioplasty they were located within the levels found in the control group (Fig. 8). Group 5: Cervical Block. In the patients with complete subarachnoid block, the ZPS and HIP were caudally shifted compared with the control group. After decompressive laminectomy the ZPS and HIp were located within the levels in the control group (Fig. 9). Group 6: One-Hour Recording. Control patients had a slight pressure rise ranging from 20 to 60 mm H~O during the l-hour pressure recording in the sitting position. This pressure rise always leveled out before the recording was ended. When changing back to the lateral position, the pressure fell to less than the pre-tilt level, which, however, was reached within 5 minutes or less. Hydrocephalic patients had pressure changes before the shunting similar to those in the control group, with a pressure rise ranging from 30 to 60 mm H20. After shunt- FIG. 9. Measurements in patients with complete cervical subarachnoid block show that the ZPS and HIP were located caudally. Before laminectomy these patients had a double set of ZPS and HIP, and by lumbar CSF pressure recording only the lower set was determined. The star (,) = the occipital protuberance. 702 J. Neurosurg. / Volume 44 / June, 1976

6 Body position and CSt: statics FIG. 10. Tracings of lumbar CSF pressure recorded for 1 hour with patients in the sitting position. Upper Tracing." Typical finding in control patients and hydrocephalic patients before shunting: a CSF pressure rise of 50 mm H20. Lower Tracing. Remarkably stable CSF pressure level after shunting in hydrocephalic patients. ing the pressure level was remarkably stable in all patients with no or only a few millimeters rise or fall in pressure. When changing back to the lateral position, pressure fell to the pre-tilt level in two patients. In three patients pressure fell to below the pre-tilt level, which was then reached within 15 minutes or less. A typical pressure recording before and after shunting is shown in Fig. 10. None of these 15 selected patients felt faint or complained of any discomfort during the pressure recording. Discussion Comparison of Lumbar CSF Pressures When comparing the lumbar CSF pressure in the lateral and sitting positions in the same patient, attention must be paid to measurement errors and orthostatic changes in filling pressure. When comparing the lumbar CSF pressure in the sitting position between patients, attention must also be paid to the individual difference in the hydrostatic pressure component. Measurement Errors Cerebrospinal Fluid Leakage. The lumbar CSF pressure in the sitting position is about three times the pressure in the lateral position, thus increasing the risk of CSF leakage during the measurement. It is therefore important to obtain a proper placement of the spinal needle at the first attempt. A No. 19 needle was found to be the thinnest needle that was practical to use; it had great maneuverability and gave a good tactile identification of the dura and arachnoidea. Correct placement of the needle at the first attempt was best achieved by performing the lumbar puncture under local anesthesia with the patient in a sitting position. Changing Body Position. To standardize orthostatic CSF pressure recording the posture must be fairly stable and reproducible. In preliminary studies we tried to make the patient keep his head up against a bar; however, the most stable and reproducible sitting position was obtained when the patient was instructed and assisted in assuming an erect but relaxed sitting position with his eyes fixed on a target on the wall. Orthostatic Changes in CSF Filling Pressure Cerebral Vasodynamics. In patients with increased intracranial pressure and a diseased brain, rapid tilting to the sitting position may result in a stationary increased CSF filling pressure? These pressure changes were usually associated with headache and discomfort, probably reflecting unstable or impaired cerebral vasoregulation. Systemic Blood Pressure. A fall in the CSF filling pressure was found in all those patients who felt dizzy and faint in the sitting position. These symptoms called orthostatic intolerance, are caused by failing arterial blood pressure (BP) leading to cerebral ischemia. 7 Psychic stimulation due to discomfort, anxiety, and pain has been found to increase orthostatic intolerance2 Consequently, it is important to keep the patient from suffering pain by performing lumbar puncture under local anesthesia, and to have a confident attitude toward the patient. A special kind of orthostatic intolerance was found in patients experiencing craniospinal block and imminent herniation in the sitting position. ~ The rise in intracranial CSF filling pressure while in the sitting position, whether transient or stationary, is probably an important factor in this development. Long-Term Changes. The long-term change in CSF filling pressure while in the sitting position was moderate and for practical purposes did not influence the 5-minute pressure J. Neurosurg. / Volume 44 / June,

7 recording. After tilting back to the lateral position, the pre-tilt pressure level was reached within 5 minutes and, after shunting, within 15 minutes. Having the patient in bed for at least 30 minutes before lumbar puncture and establishing a 5-minute stable pressure level in the lateral position before tilting should thus be considered a sufficient period of pressure stabilization when recording CSF pressure in daily practice. Difference in Hydrostatic Pressure Component When recording the lumbar CSF pressure with the patient in the lateral position, the hydrostatic pressure component is related to the breadth of the head. The individual difference is small, and negligible for practical purposes. Thus the pressure recorded is mainly a measure of the degree of filling of the CSF space and, therefore, comparable from one patient to another. When recording the lumbar CSF pressure with the patient in the sitting position, the hydrostatic pressure component, which is related to the length of the body, shows considerable individual variation and must be taken into account. For this the length of the body is used as the unit of measurement by determining the ZPS, which eliminates, for practical purposes, the individual difference in hydrostatic pressure component. This seemed to be verified by the fact that the ZPS in control patients showed nearly the same frequency distribution and variation as the CSF pressure in the lateral position (Figs. 3 and 4). Hydrostatic Indifferent Point The HIP in a fluid space must always be defined for certain positions. Model studies 1'~ have shown the position of the HIP to depend on the relative "give" of the ends of a tube. If the distensibility is equal around a horizontal line, the HIP is located in the middle of the tube and does not shift when the filling pressure is altered. This is the situation when measuring the lumbar CSF pressure in the lateral position. The HIP for right and left lateral positions is then located on the sagittal midline which is also the zero reference level. When the distensibility differs, the HIP moves toward the more distensible side, and is also shifted when the filling pressure changes. This is the situation when measuring B. Magnaes the lumbar CSF pressure in the lateral position in patients with asymmetrical skull defects. It is also the situation when measuring the lumbar CSF pressure with the patient in the sitting position and determining the HIP for the lateral and sitting positions. In accord with this fact is the finding of a caudally-shifted HIP after shunting and a cranially-shifted HIP in patients with large, flaccid skull defects. Clinical Implications Pressure Fall on CSF Shunting. The pressure fall while in the sitting position was larger than the pressure fall while in the lateral position (Fig. 6). The pressure fall recorded in the lateral position was the reduction in CSF filling pressure, while the pressure fall recorded in the sitting position was the reduction in CSF filling pressure plus the caudal shift of the HIP. This "magnification" of the pressure fall on shunting makes the ZPS a useful variable in control of CSF shunt function. If the pressure recording includes a stationary increased filling pressure while in the sitting position before shunting, then the difference between the pressure fall while in the lateral and sitting positions on shunting will be even larger. Spinal Subarachnoid Block. Patients with a complete cervical block had a double set of ZPS and HIP, and by lumbar puncture only the lower set is measured. Thus, the finding of a caudally-located ZPS in a patient with a spinal disease is strongly indicative of a complete subarachnoid block. CSF Leakage Cranial to the HIP. The CSF pressure cranial to the HIP is lowered when changing from the lateral to the sitting position. Thus, if the dura has been opened above the upper thoracic region during surgery, then there is no reason, as far as the hydrostatic pressure component is concerned, to keep the patient strictly in bed postoperatively for the purpose of preventing CSF leakage. The patient may be allowed to sit or walk for periods of 15 minutes, as there is only a slight increase in the filling pressure within this period of time (Fig. 10). If there already is a leakage, then the HIP is probably shifted caudally (Fig. 7), and the need for keeping the patient strictly in bed is probably even less. The possibility of air entering the CSF space must, however, be taken into consideration. 704 J. Neurosurg. / Volume 44 / June, 1976

8 Body position and CSF statics Acknowledgment I am grateful to electrical engineer Rune Aaslid for valuable discussions and advice on the biophysical aspects of this paper. References 1. Clark JH, Hooker DR, Weed LH: The hydrostatic factor in venous pressure measurements. Am J Physiol 109: , Fox JL, McCullough DC, Green RC: Effect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics. 2. A new technique of pressure measurements, results, and concepts. 3. A concept of hydrocephalus. J Neurol Neurosurg Psychiatry 36: , Gauer OH, Thron HL: Postural changes in the circulation, in Hamilton WF (ed): Handbook of Physiology, Section 2: Circulation. Volume 3. Baltimore: Williams & Wilkins, 1965, pp Langfitt TW: Increased intracranial pressure. Clin Neurosurg 16: , Magnaes B: Body position and cerebrospinal fluid pressure. Part 1: Clinical studies on the effect of rapid postural changes. J. Neurosurg 44: , Portnoy HD, Schulte RR, Fox JL, et al: Antisiphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas. J Neurosurg 38: , Samnegfird H: Studies on internal carotid artery blood flow in man. Electromagnetic flowmetry after carotid artery surgery. Seand J Thorae Cardiovase Surg 8 (Suppl 13):1-29, Stevens PM: Cardiovascular dynamics during orthostasis and the influence of intravascular instrumentation. Am J Cardiol 17: , 1966 Address reprint requests to: BjCrn Magnaes, M.D., Department of Neurosurgery, Rikshospitalet, Oslo 1, Norway. J. Neurosurg. / Volume 44 / June,

Mechanisms of Headache in Intracranial Hypotension

Mechanisms of Headache in Intracranial Hypotension Mechanisms of Headache in Intracranial Hypotension Stephen D Silberstein, MD Jefferson Headache Center Thomas Jefferson University Hospital Philadelphia, PA Stephen D. Silberstein, MD, FACP Director, Jefferson

More information

Ventricles, CSF & Meninges. Steven McLoon Department of Neuroscience University of Minnesota

Ventricles, CSF & Meninges. Steven McLoon Department of Neuroscience University of Minnesota Ventricles, CSF & Meninges Steven McLoon Department of Neuroscience University of Minnesota 1 Coffee Hour Thursday (Sept 14) 8:30-9:30am Surdyk s Café in Northrop Auditorium Stop by for a minute or an

More information

Ventriculo peritoneal Shunt Malfunction with Anti-siphon Device in Normal pressure Hydrocephalus Report of -Three Cases-

Ventriculo peritoneal Shunt Malfunction with Anti-siphon Device in Normal pressure Hydrocephalus Report of -Three Cases- Ventriculo peritoneal Shunt Malfunction with Anti-siphon Device in Normal pressure Hydrocephalus Report of -Three Cases- Mitsuru SEIDA, Umeo ITO, Shuichi TOMIDA, Shingo YAMAZAKI and Yutaka INABA* Department

More information

PTA 106 Unit 1 Lecture 3

PTA 106 Unit 1 Lecture 3 PTA 106 Unit 1 Lecture 3 The Basics Arteries: Carry blood away from the heart toward tissues. They typically have thicker vessels walls to handle increased pressure. Contain internal and external elastic

More information

VERTEBRAL COLUMN ANATOMY IN CNS COURSE

VERTEBRAL COLUMN ANATOMY IN CNS COURSE VERTEBRAL COLUMN ANATOMY IN CNS COURSE Vertebral body Sections of the spine Atlas (C1) Axis (C2) What type of joint is formed between atlas and axis? Pivot joint What name is given to a fracture of both

More information

Under Pressure. Dr. Robert Keyes CAEP -- Critical Care May 31, 2015

Under Pressure. Dr. Robert Keyes CAEP -- Critical Care May 31, 2015 Under Pressure Dr. Robert Keyes CAEP -- Critical Care May 31, 2015 Disclosures 1. No disclosures, commercial supports, or conflicts of interest. Learning Objectives 1. To understand the principles of pressure

More information

Lumbar cistern is site of lumbar puncture for removal of CSF sample LC contains cauda equina. Anatomical Review

Lumbar cistern is site of lumbar puncture for removal of CSF sample LC contains cauda equina. Anatomical Review Lumbar Puncture Lumbar cistern is site of lumbar puncture for removal of CSF sample LC contains cauda equina Anatomical Review Anatomical review Overview An LP (lumbar puncture) is an invasive diagnostic

More information

Spontaneous Intracranial Hypotension Diagnosis and Treatment

Spontaneous Intracranial Hypotension Diagnosis and Treatment Spontaneous Intracranial Hypotension Diagnosis and Treatment John W. Engstrom MD, Philip R. Weinstein MD, and William P. Dillon M.D. University of California, San Francisco Spontaneous Intracranial Hypotension

More information

Tutorials. By Dr Sharon Truter

Tutorials. By Dr Sharon Truter Tutorials By Dr Sharon Truter To the Tutorials By Dr Sharon Truter What to expect from the Tutorials What to expect from these tutorials Outlines, structure, guided reading, explanations, mnemonics Begin

More information

longitudinal sinus. A decrease in blood flow was observed when the pressure

longitudinal sinus. A decrease in blood flow was observed when the pressure 362 J. Physiol. (I942) IOI, 362-368 6I2.I44:6I2.824 THE EFFECT OF VARIATIONS IN THE SU.BARACHNOID PRESSURE ON THE VENOUS PRESSURE IN THE SUPERIOR LONGITUDINAL SINUS AND IN THE TORCULAR OF THE DOG BY T.

More information

Meninges and Ventricles

Meninges and Ventricles Meninges and Ventricles Irene Yu, class of 2019 LEARNING OBJECTIVES Describe the meningeal layers, the dural infolds, and the spaces they create. Name the contents of the subarachnoid space. Describe the

More information

PA SYLLABUS. Syllabus for students of the FACULTY OF MEDICINE No.2

PA SYLLABUS. Syllabus for students of the FACULTY OF MEDICINE No.2 Approved At the meeting of the Faculty Council Medicine No. of Approved At the meeting of the chair of Neurosurgery No. of Dean of the Faculty Medicine No.2 PhD, associate professor M. Betiu Head of the

More information

Intracranial hypotension secondary to spinal CSF leak: diagnosis

Intracranial hypotension secondary to spinal CSF leak: diagnosis Intracranial hypotension secondary to spinal CSF leak: diagnosis Spinal cerebrospinal fluid (CSF) leak is an important and underdiagnosed cause of new onset headache that is treatable. Cerebrospinal fluid

More information

Ventriculo-Peritoneal/ Lumbo-Peritoneal Shunts

Ventriculo-Peritoneal/ Lumbo-Peritoneal Shunts Ventriculo-Peritoneal/ Lumbo-Peritoneal Shunts Exceptional healthcare, personally delivered Ventriculo-Peritoneal/ Lumbo-Peritoneal Shunts What is hydrocephalus? Hydrocephalus is the build up of an excess

More information

The dura is sensitive to stretching, which produces the sensation of headache.

The dura is sensitive to stretching, which produces the sensation of headache. Dural Nerve Supply Branches of the trigeminal, vagus, and first three cervical nerves and branches from the sympathetic system pass to the dura. Numerous sensory endings are in the dura. The dura is sensitive

More information

A telescopic ventriculoatrial shunt that elongates with growth

A telescopic ventriculoatrial shunt that elongates with growth A telescopic ventriculoatrial shunt that elongates with growth Technical note BURTON L. WISE, M.D. Department of Surgery (Neurosurgery) and Neurological Institute, Mount Zion Hospital and Medical Center,

More information

PRIVILEGE APPLICATION FORM - [Mercy Medical Center]

PRIVILEGE APPLICATION FORM - [Mercy Medical Center] Current Privilege Status Key Practitioner's Current Privilege status is signified in ( ) preceding each privilege. G = W = Withdrawn T = Temporary P = With Proctor A = Assist with C = With Consult E =

More information

2. The vertebral arch is composed of pedicles (projecting from the body) and laminae (uniting arch posteriorly).

2. The vertebral arch is composed of pedicles (projecting from the body) and laminae (uniting arch posteriorly). VERTEBRAL COLUMN 2018zillmusom I. VERTEBRAL COLUMN - functions to support weight of body and protect spinal cord while permitting movements of trunk and providing for muscle attachments. A. Typical vertebra

More information

1 Normal Anatomy and Variants

1 Normal Anatomy and Variants 1 Normal Anatomy and Variants 1.1 Normal Anatomy MR Technique. e standard MR protocol for a routine evaluation of the spine always comprises imaging in sagittal and axial planes, while coronal images are

More information

INCREASED INTRACRANIAL PRESSURE

INCREASED INTRACRANIAL PRESSURE INCREASED INTRACRANIAL PRESSURE Sheba Medical Center, Acute Medicine Department Irene Frantzis P-Year student SGUL 2013 Normal Values Normal intracranial volume: 1700 ml Volume of brain: 1200-1400 ml CSF:

More information

CHANGES IN INTRACRANIAL PRESSURE ASSOCIATED WITH EXTRADURAL ANAESTHESIA

CHANGES IN INTRACRANIAL PRESSURE ASSOCIATED WITH EXTRADURAL ANAESTHESIA Br. J. Anaesth. (1986), 58, 676680 CHANGES IN INTRACRANIAL PRESSURE ASSOCIATED WITH EXTRADURAL ANAESTHESIA H. HILT, H.J. GRAMM AND J. LINK Extradural blockade is commonly used in our clinic to provide

More information

Surgical Privileges Form: "Neurosurgery" Clinical Privileges Request. Requested (To be completed by the applicant) Not Recommended (For committee use)

Surgical Privileges Form: Neurosurgery Clinical Privileges Request. Requested (To be completed by the applicant) Not Recommended (For committee use) Surgical Form: Clinical Request "Neurosurgery" Applicant s Name:. License No. (If Any):... Date:... Scope of Practice:. Facility:.. Place of Work:. the applicant) CATEGORY I: Core : 1. Interpretation of

More information

Ligaments of the vertebral column:

Ligaments of the vertebral column: In the last lecture we started talking about the joints in the vertebral column, and we said that there are two types of joints between adjacent vertebrae: 1. Between the bodies of the vertebrae; which

More information

LV-EBP: Record-setting large volume epidural blood patch

LV-EBP: Record-setting large volume epidural blood patch LV-EBP: Record-setting large volume epidural blood patch Michael D. Staudt Department of Clinical Neurological Sciences Schulich School of Medicine, Western University London Health Sciences Centre, London,

More information

Ian Carroll MD, MS https://med.stanford.edu/profiles/ian-carroll CarrollCSFleak@gmail.com SIH and/or POTS? Disclosures No Conflicts of Interest This work is supported by the Considine CSF Leaks Fund Thank

More information

Ventricular size after shunting for idiopathic normal pressure hydrocephalus

Ventricular size after shunting for idiopathic normal pressure hydrocephalus Journal of Neurology, Neurosurgery, and Psychiatry, 1975, 38, 833-837 Ventricular size after shunting for idiopathic normal pressure hydrocephalus HENRY A. SHENKIN', JACK 0. GREENBERG, AND CHARLES B. GROSSMAN

More information

the back book Your Guide to a Healthy Back

the back book Your Guide to a Healthy Back the back book Your Guide to a Healthy Back anatomy Your spine s job is to: Support your upper body and neck Increase flexibility of your spine Protect your spinal cord There are 6 primary components of

More information

HEAD AND NECK IMAGING. James Chen (MS IV)

HEAD AND NECK IMAGING. James Chen (MS IV) HEAD AND NECK IMAGING James Chen (MS IV) Anatomy Course Johns Hopkins School of Medicine Sept. 27, 2011 OBJECTIVES Introduce cross sectional imaging of head and neck Computed tomography (CT) Review head

More information

Diagnosis and treatment of spontaneous intracranial hypotension due to cerebrospinal fluid leakage

Diagnosis and treatment of spontaneous intracranial hypotension due to cerebrospinal fluid leakage DOI 10.1186/s40064-016-3775-z CASE STUDY Open Access Diagnosis and treatment of spontaneous intracranial hypotension due to cerebrospinal fluid leakage Yake Zheng 1, Yajun Lian 1*, Chuanjie Wu 1, Chen

More information

Perioperative Management Of Extra-Ventricular Drains (EVD)

Perioperative Management Of Extra-Ventricular Drains (EVD) Perioperative Management Of Extra-Ventricular Drains (EVD) Dr. Vijay Tarnal MBBS, FRCA Clinical Assistant Professor Division of Neuroanesthesiology Division of Head & Neck Anesthesiology Michigan Medicine

More information

Subarachnoid Haemorrhage

Subarachnoid Haemorrhage 2011 Subarachnoid Haemorrhage Subarachnoid Haemorrhage This pamphlet will briefly describe what may happen to a person who has a subarachnoid haemorrhage (SAH). We would like to encourage you to read this

More information

Drawing Blood From the Llama (Venipuncture)

Drawing Blood From the Llama (Venipuncture) Drawing Blood From the Llama (Venipuncture) Drawing blood (venipuncture) in the llama is more difficult than in common domestic animals. Their wooly fleece impairs visibility when you try to locate the

More information

LUMBAR PUNCTURE. Multimedia Health Education

LUMBAR PUNCTURE. Multimedia Health Education LUMBAR PUNCTURE Disclaimer This film is an educational resource only and should not be used to make a decision on. All such decisions must be made in consultation with a physician or licensed healthcare

More information

Enhancement of Cranial US: Utility of Supplementary Acoustic Windows and Doppler Harriet J. Paltiel, MD

Enhancement of Cranial US: Utility of Supplementary Acoustic Windows and Doppler Harriet J. Paltiel, MD Enhancement of Cranial US: Utility of Supplementary Acoustic Windows and Doppler Harriet J. Paltiel, MD Boston Children s Hospital Harvard Medical School None Disclosures Conventional US Anterior fontanelle

More information

STANDARDIZED PROCEDURE LUMBAR PUNCTURE (Adult, Peds)

STANDARDIZED PROCEDURE LUMBAR PUNCTURE (Adult, Peds) I. Definition The lumbar puncture (LP) may assist in the diagnosis of meningitis, encephalitis, metastatic carcinomas, brain tumors, leukemia, demyelinating conditions, brain or spinal cord abscesses,

More information

Anterior Cervical Discectomy and Fusion Surgery

Anterior Cervical Discectomy and Fusion Surgery Disclaimer This movie is an educational resource only and should not be used to manage orthopaedic health. All decisions about the management of orthopaedic conditions must be made in conjunction with

More information

Normal cerebrospinal fluid pressure

Normal cerebrospinal fluid pressure OLOF GILLAND, M.D., PH.D., WALLACE W. TOURTELLOTTE, M.D., PH.D., LORCAN O'TAUMA, M.D., AND WILLIAM C. HENDERSON, PtI.D. Departments of Neurology Veterans Administration Wadsworth Hospital Center, and University

More information

Tension-Type Headache

Tension-Type Headache Chronic Headache Tension-Type Headache Its mechanism and treatment JMAJ 47(3): 130 134, 2004 Manabu SAKUTA Chief Professor, First Internal Medicine (Neurology), Kyorin University Abstract: Tension-type

More information

Unit #3: Dry Lab A. David A. Morton, Ph.D.

Unit #3: Dry Lab A. David A. Morton, Ph.D. Unit #3: Dry Lab A David A. Morton, Ph.D. Skull Intracranial Hemorrhage Pg. 26 Epidural Hematoma Pg. 26 Skull Pg. 26 Subdural Hematoma Pg. 26 Subdural Hematoma Pg. 26 Subarachnoid Hemorrhage Pg. 26 Subarachnoid

More information

5.5. RETROSIGMOID APPROACH

5.5. RETROSIGMOID APPROACH 5.5. RETROSIGMOID APPROACH The retrosigmoid approach provides good access to the cerebellopontine angle. It is by far simpler and faster with much less need for bone removal than other more extensive lateral

More information

A Study to Formulate a Strategy to Prevent Ventriculoperitoneal Shunt Infection

A Study to Formulate a Strategy to Prevent Ventriculoperitoneal Shunt Infection 74 Original Article THIEME A Study to Formulate a Strategy to Prevent Ventriculoperitoneal Shunt Infection T. P. Jeyaselvasenthilkumar 1 V. G. Ramesh 1 C. Sekar 1 S. Sundaram 1 1 Department of Neurosurgery,

More information

TUMOURS IN THE REGION OF FORAMEN MAGNUM

TUMOURS IN THE REGION OF FORAMEN MAGNUM TUMOURS IN THE REGION OF FORAMEN MAGNUM Abstract Pages with reference to book, From 119 To 122 Naim-ur-Rahman ( Department of Neurosurgery, Rawalpindi Medical College, Rawalpindi. ) A very unusual case

More information

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 3/12/2011 Radiology Quiz of the Week # 11 Page 1 CLINICAL PRESENTATION AND RADIOLOGY

More information

CISTERNOGRAPHY (CEREBRO SPINAL FLUID IMAGING): A VERSATILE DIAGNOSTIC PROCE DURE

CISTERNOGRAPHY (CEREBRO SPINAL FLUID IMAGING): A VERSATILE DIAGNOSTIC PROCE DURE VOL. 115, No. i E D I T 0 R I A L CISTERNOGRAPHY (CEREBRO SPINAL FLUID IMAGING): A VERSATILE DIAGNOSTIC PROCE DURE C ISTERNOGRAPHY (CSF imaging) is a diagnostic study based on the premise that certain

More information

EFFECTS OF SUDDEN AND PROLONGED STANDING FROM SUPINE POSTURE ON HEART RATE, ECG-PATTERN AND BLOOD PRESSURE

EFFECTS OF SUDDEN AND PROLONGED STANDING FROM SUPINE POSTURE ON HEART RATE, ECG-PATTERN AND BLOOD PRESSURE J. Human Ergol.,17: 3-12,1988 Center for Academic Publications Japan. Printed in Japan. EFFECTS OF SUDDEN AND PROLONGED STANDING FROM SUPINE POSTURE ON HEART RATE, ECG-PATTERN AND BLOOD PRESSURE Satipati

More information

Neurosurgical Techniques

Neurosurgical Techniques Neurosurgical Techniques Neurosurgical Techniques Laminectomy for the Removal of Spinal Cord Tumors J. GRAFTON LOVE, M.D. Section of Neurologic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

More information

Posterior surgical procedures are those procedures

Posterior surgical procedures are those procedures 9 Cervical Posterior surgical procedures are those procedures that have been in use for a long time with established efficacy in the treatment of radiculopathy and myelopathy caused by pathologies including

More information

Medical Management of Intracranial Hypertension. Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center

Medical Management of Intracranial Hypertension. Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center Medical Management of Intracranial Hypertension Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center Anatomic and Physiologic Principles Intracranial compartments Brain 80% (1,400

More information

Lumbar puncture. Invasive procedure: diagnostic or therapeutic. The subarachnoid space 4-13 ys: ml Replenished: 4-6 h Routine LP (3-5 ml): <1h

Lumbar puncture. Invasive procedure: diagnostic or therapeutic. The subarachnoid space 4-13 ys: ml Replenished: 4-6 h Routine LP (3-5 ml): <1h Lumbar puncture Lumbar puncture Invasive procedure: diagnostic or therapeutic. The subarachnoid space 4-13 ys: 65-150ml Replenished: 4-6 h Routine LP (3-5 ml):

More information

Iatrogenic lumbar Pseudomeningocele: A case report and review of literature

Iatrogenic lumbar Pseudomeningocele: A case report and review of literature Available online at Available online at: www.ijmrhs.com ISSN No: 2319-5886 International Journal of Medical Research & Health Sciences, 2016, 5, 1:153-157 Iatrogenic lumbar Pseudomeningocele: A case report

More information

POSTERIOR CERVICAL FUSION

POSTERIOR CERVICAL FUSION AN INTRODUCTION TO PCF POSTERIOR CERVICAL FUSION This booklet provides general information on the Posterior Cervical Fusion (PCF) surgical procedure for you to discuss with your physician. It is not meant

More information

Chapter 7 The Skeletal System:The Axial Skeleton

Chapter 7 The Skeletal System:The Axial Skeleton Chapter 7 The Skeletal System:The Axial Skeleton Axial Skeleton 80 bones lie along longitudinal axis skull, hyoid, vertebrae, ribs, sternum, ear ossicles Appendicular Skeleton 126 bones upper & lower limbs

More information

Injuries to the head and spine

Injuries to the head and spine Injuries to the head and spine Aaron J. Katz, AEMT-P, CIC www.es26medic.net 2013 Nervous System Two sub-systems Central Nervous System ( CNS ) Brain and spinal cord Peripheral Nervous System 12 cranial

More information

Relationship between flexion of the neck and changes in intracranial pressure

Relationship between flexion of the neck and changes in intracranial pressure Relationship between flexion of the neck and changes in intracranial pressure Sarah Hornshoej, Alexander Lilja, Morten Andresen, Marianne Juhler Sarah Hornshoej Tel: +45 50494809 Clinic of Neurosurgery,

More information

Adult hydrocephalus and shunts. Information for patients

Adult hydrocephalus and shunts. Information for patients Adult hydrocephalus and shunts Information for patients Contents What is hydrocephalus? 3 Causes 4 Symptoms 4 What is hydrocephalus? Hydrocephalus is a condition in which cerebrospinal fluid (CSF) builds

More information

Chapter IV: Percutaneous Puncture of Spinal Cord Cysts

Chapter IV: Percutaneous Puncture of Spinal Cord Cysts Acta Radiologica: Diagnosis ISSN: 0567-8056 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/iard19 Chapter IV: Percutaneous Puncture of Spinal Cord Cysts To cite this article: (1966)

More information

RECONSTRUCTING OUR PATIENT S LIVES WHAT THE NUMBERS REALLY MEAN FOR THE NEUROSURGICAL PATIENT

RECONSTRUCTING OUR PATIENT S LIVES WHAT THE NUMBERS REALLY MEAN FOR THE NEUROSURGICAL PATIENT RECONSTRUCTING OUR PATIENT S LIVES WHAT THE NUMBERS REALLY MEAN FOR THE NEUROSURGICAL PATIENT In the beginning... Current Procedural Terminology 1966 International Classification of Diseases go back to

More information

Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma

Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma Exp Neurobiol. 2015 Dec;24(4):366-370. pissn 1226-2560 eissn 2093-8144 Case Report Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma Jung-Hwan Oh

More information

Introduction to Neurosurgical Subspecialties:

Introduction to Neurosurgical Subspecialties: Introduction to Neurosurgical Subspecialties: Trauma and Critical Care Neurosurgery Brian L. Hoh, MD 1, Gregory J. Zipfel, MD 2 and Stacey Q. Wolfe, MD 3 1 University of Florida, 2 Washington University,

More information

GEORGE E. PERRET, M.D., AND CARL J. GRAF, M.D.

GEORGE E. PERRET, M.D., AND CARL J. GRAF, M.D. J Neurosurg 47:590-595, 1977 Subgaleal shunt for temporary ventricle decompression and subdural drainage GEORGE E. PERRET, M.D., AND CARL J. GRAF, M.D. Division of Neurological Surgery, University of Iowa

More information

Synovial cyst of spinal facet

Synovial cyst of spinal facet Case report CHUN C. KAO, M.D., STEFAN S. WINKLER, M.D., AND J. H. TURNER, M.D. Sections of Neurosurgery, Radiology, and Pathology, Madison Veterans Administration Hospital, and University of Wisconsin,

More information

Lumbar drains. Information for patients Neurosurgery

Lumbar drains. Information for patients Neurosurgery Lumbar drains Information for patients Neurosurgery Why do I need drainage of my cerebrospinal fluid (CSF)? The brain and spinal cord are bathed in clear fluid like a baby in the womb. This cerebrospinal

More information

Brain Meninges, Ventricles and CSF

Brain Meninges, Ventricles and CSF Brain Meninges, Ventricles and CSF Lecture Objectives Describe the arrangement of the meninges and their relationship to brain and spinal cord. Explain the occurrence of epidural, subdural and subarachnoid

More information

Stroke & Neurovascular Center of New Jersey. Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center

Stroke & Neurovascular Center of New Jersey. Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center Stroke & Neurovascular Center of New Jersey Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center Past, present and future Past, present and future Cerebral Blood Flow Past, present and future

More information

National Hospital for Neurology and Neurosurgery

National Hospital for Neurology and Neurosurgery National Hospital for Neurology and Neurosurgery Venous sinus stents (for the treatment of venous sinus stenosis and idiopathic intracranial hypertension) Lysholm Department of Neuroradiology If you would

More information

EFFECTS OF VERTEBRAL AXIAL DECOMPRESSION (VAX-D) ON INTRADISCAL PRESSURE

EFFECTS OF VERTEBRAL AXIAL DECOMPRESSION (VAX-D) ON INTRADISCAL PRESSURE EFFECTS OF VERTEBRAL AXIAL DECOMPRESSION (VAX-D) ON Gustavo Ramos, M.D., William Marin, M.D. Journal of Neursurgery 81:35-353 1994 Departments of Neurosurgery and Radiology, Rio Grande Regional Hospital,

More information

The Sequence of Alterations in the Vital Signs During Acute Experimental Increased Intracranial Pressure*

The Sequence of Alterations in the Vital Signs During Acute Experimental Increased Intracranial Pressure* J. Neurosurg. / Volume 32 / January, 1970 The Sequence of Alterations in the Vital Signs During Acute Experimental Increased Intracranial Pressure* JAVAD HEKMATPANAH, M.D. Division o/ Neurological Surgery,

More information

Cranio-cervical decompression. Information for patients Neurosurgery

Cranio-cervical decompression. Information for patients Neurosurgery Cranio-cervical decompression Information for patients Neurosurgery page 2 of 12 What is a cranio-cervical decompression? A cranio-cervical decompression is an operation involving the back of the head

More information

Transitioning to the Suboccipital Triangle. Suboccipital Triangle

Transitioning to the Suboccipital Triangle. Suboccipital Triangle Transitioning to the Suboccipital Triangle Syllabus p. 14-15 Suboccipital Triangle Borders -Rectus capitis posterior major -Obliquus capitis superior -Obliquus capitis inferior Contents -Vertebral artery

More information

REVIEW QUESTIONS ON VERTEBRAE, SPINAL CORD, SPINAL NERVES

REVIEW QUESTIONS ON VERTEBRAE, SPINAL CORD, SPINAL NERVES REVIEW QUESTIONS ON VERTEBRAE, SPINAL CORD, SPINAL NERVES 1. A 28-year-old-women presented to the hospital emergency room with intense lower back spasms in the context of coughing during an upper respiratory

More information

Upward spinal coning: impaction of occult spinal tumours following relief of hydrocephalus

Upward spinal coning: impaction of occult spinal tumours following relief of hydrocephalus Journal of Neurology, Neurosurgery, and Psychiatry 1984;47: 386-390 Upward spinal coning: impaction of occult spinal tumours following relief of hydrocephalus RASHID JOOMA, RICHARD D HAYWARD From the Departments

More information

fontanelle without puncture

fontanelle without puncture Journal of Neurology, Neurosurgery, and Psychiatry, 1974, 37, 88-96 Methods of measuring intracranial pressure via the fontanelle without puncture S. R. WEALTHALL' AND R. SMALLWOOD From the Department

More information

Low Res SAMPLE SPINAL CURVES THE SPINE

Low Res SAMPLE SPINAL CURVES THE SPINE THE SPINE The normal healthy spine has a naturally curved shape. Like a coiled spring, these curves help to absorb some of the forces that are placed on your spine while standing erect. When looking at

More information

Occult cervical (C1 2) dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch

Occult cervical (C1 2) dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch J Neurosurg Spine 9:000 000, 9:483 487, 2008 Occult cervical (C1 2) dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch Case report As o k u m a r

More information

Epilepsy after two different neurosurgical approaches

Epilepsy after two different neurosurgical approaches Journal ofneurology, Neurosurgery, and Psychiatry, 1976, 39, 1052-1056 Epilepsy after two different neurosurgical approaches to the treatment of ruptured intracranial aneurysm R. J. CABRAL, T. T. KING,

More information

Intrafractional Junction Shifts Utilizing Multileaf Collimation: A Novel CSI Planning Technique. Rodney Hood RT(R)(T)CMD

Intrafractional Junction Shifts Utilizing Multileaf Collimation: A Novel CSI Planning Technique. Rodney Hood RT(R)(T)CMD Intrafractional Junction Shifts Utilizing Multileaf Collimation: A Novel CSI Planning Technique Rodney Hood RT(R)(T)CMD Happy Father s Day! Quiet Room Beam me up Scotty! What is CSI? CSI-DURHAM! CSI Craniospinal

More information

Papilledema. Golnaz Javey, M.D. and Jeffrey J. Zuravleff, M.D.

Papilledema. Golnaz Javey, M.D. and Jeffrey J. Zuravleff, M.D. Papilledema Golnaz Javey, M.D. and Jeffrey J. Zuravleff, M.D. Papilledema specifically refers to optic nerve head swelling secondary to increased intracranial pressure (IICP). Optic nerve swelling from

More information

fontanelle without puncture

fontanelle without puncture Journal of Neurology, Neurosurgery, and Psychiatry, 1974, 37, 88-96 Methods of measuring intracranial pressure via the fontanelle without puncture S. R. WEALTHALL' AND R. SMALLWOOD From the Department

More information

Case Log Mapping Update: April 2018 Review Committee for Neurological Surgery

Case Log Mapping Update: April 2018 Review Committee for Neurological Surgery Case Log Mapping Update: April 2018 Review Committee for Neurological Surgery The Review Committee has made the following changes to the CPT code mappings: The following previously untracked CPT codes

More information

A MODEL OF CEREBRAL BLOOD FLOW DURING SUSTAINED ACCELERATION. S. Cirovic 1 C. Walsh 2 W. D. Fraser 3

A MODEL OF CEREBRAL BLOOD FLOW DURING SUSTAINED ACCELERATION. S. Cirovic 1 C. Walsh 2 W. D. Fraser 3 16-l A MODEL OF CEREBRAL BLOOD FLOW DURING SUSTAINED ACCELERATION S. Cirovic 1 C. Walsh 2 W. D. Fraser 3 1. Institute for Aerospace Studies, University of Toronto, Ontario, Canada 2. Department of Mechanical

More information

Changes in Intracranial Pressure in Various Positions of the Head in Anaesthetised Patients

Changes in Intracranial Pressure in Various Positions of the Head in Anaesthetised Patients Bahrain Medical Bulletien, Vol. 25, No. 4, December 2003 Changes in Intracranial Pressure in Various Positions of the Head in Anaesthetised Patients Vinod K Grover, MD,MNAMS* Indu Bala, MD ** Someshwar

More information

Cervical laminectomy for spinal cord compression. Information for patients Neurosurgery

Cervical laminectomy for spinal cord compression. Information for patients Neurosurgery Cervical laminectomy for spinal cord compression Information for patients Neurosurgery What is a compression of the spinal cord and how has it been caused? The bones in our back are called vertebras and

More information

Incidental Durotomy/ Dural Tear.

Incidental Durotomy/ Dural Tear. Incidental Durotomy/ Dural Tear www.fisiokinesiterapia.biz Objectives Define dural tear ( incidental durotomy ) Differentiate dural tears from other accidental punctures or lacerations I.D. Risk factors

More information

Hydrocephalus 1/16/2015. Hydrocephalus. Functions of Cerebrospinal fluid (CSF) Flow of CSF

Hydrocephalus 1/16/2015. Hydrocephalus. Functions of Cerebrospinal fluid (CSF) Flow of CSF Hydrocephalus Hydrocephalus Ruth Arms, MSN, CNS-BC, SCRN Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles

More information

Clinical Advances 1n the Management of Patients with Severe Head Injury*

Clinical Advances 1n the Management of Patients with Severe Head Injury* Clinical Advances 1n the Management of Patients with Severe Head Injury* THOMAS W. LANGFITT, M.D. Charles H. Frazier Professor and Chairman, Division of Neurosurgery, University of Pennsylvania, Philadelphia

More information

secondary effects and sequelae of head trauma.

secondary effects and sequelae of head trauma. Neuroimaging of vascular/secondary secondary effects and sequelae of head trauma. Andrès Server Alonso Department of Neuroradiology Division of Radiology Ullevål University Hospital Oslo, Norway. Guidelines

More information

Posture. Kinesiology RHS 341 Lecture 10 Dr. Einas Al-Eisa

Posture. Kinesiology RHS 341 Lecture 10 Dr. Einas Al-Eisa Posture Kinesiology RHS 341 Lecture 10 Dr. Einas Al-Eisa Posture = body alignment = the relative arrangement of parts of the body Changes with the positions and movements of the body throughout the day

More information

Chicago Chiropractic & Sports Injury Centers Dr. Alden Clendenin DC, CCSP

Chicago Chiropractic & Sports Injury Centers Dr. Alden Clendenin DC, CCSP Cervical Lordotic Traction The soft forward [lordotic] curve at the middle of the cervical spine is critical as a shock absorber for the full weight of the head. Loss of cervical lordosis, often called

More information

T HIS paper presents an experimental

T HIS paper presents an experimental CIRCULATION OF THE CEREBROSPINAL FLUID DEMONSTRATION OF THE CHOROID PLEXUSES AS THE GENERATOR OF THE FORCE FOR FLOW OF FLUID AND VENTRICULAR ENLARGEMENT* EDGAR A. BERING, JR., M.D. Neurosurgical Research

More information

8th Annual NKY TBI Conference 3/28/2014

8th Annual NKY TBI Conference 3/28/2014 Closed Head Injury: Headache to Herniation A N T H O N Y T. K R A M E R U N I V E R S I T Y O F C I N C I N N A T I B L U E A S H E M S T E C H N O L O G Y P R O G R A M Objectives Describe the pathological

More information

MRI MEASUREMENTS OF CRANIOSPINAL AND INTRACRANIAL VOLUME CHANGE IN HEALTHY AND HEAD TRAUMA CASES

MRI MEASUREMENTS OF CRANIOSPINAL AND INTRACRANIAL VOLUME CHANGE IN HEALTHY AND HEAD TRAUMA CASES 1of 4 MRI MEASUREMENTS OF CRANIOSPINAL AND INTRACRANIAL VOLUME CHANGE IN HEALTHY AND HEAD TRAUMA CASES N. Alperin, Y. Kadkhodayan, B. Varadarajalu, C. Fisher, B. Roitberg Department of Radiology and Neurosurgery,

More information

Two-Stage Management of Mega Occipito Encephalocele

Two-Stage Management of Mega Occipito Encephalocele Two-Stage Management of Mega Occipito Encephalocele CASE REPORT A I Mardzuki*, J Abdullah**, G Ghazaime*, A R Ariff!'*, M Ghazali* *Department of Neurosciences, **Department of Radiology, Hospital Universiti

More information

Complications of Spontaneous Intracranial Hypotension

Complications of Spontaneous Intracranial Hypotension Complications of Spontaneous Intracranial Hypotension Poster No.: C-0890 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Exhibit K. Endo, Y. Kubo, M. Ida; Tokyo/JP Hemorrhage, Embolism / Thrombosis,

More information

SUPRAPUBIC PUNCTURE IN THE TREATMENT OF NEUROGENIC BLADDER

SUPRAPUBIC PUNCTURE IN THE TREATMENT OF NEUROGENIC BLADDER SUPRAPUBIC PUNCTURE IN THE TREATMENT OF NEUROGENIC BLADDER CHARLES C. HIGGINS, M.D. W. JAMES GARDNER, M.D. WM. A. NOSIK, M.D. The treatment of "cord bladder", a disturbance of bladder function from disease

More information

Effects of Vertebral Axial Decompression On Intradiscal Pressure. Ramos G., MD, Martin W., MD, Journal of Neurosurgery 81: , 1994 ABSTRACT

Effects of Vertebral Axial Decompression On Intradiscal Pressure. Ramos G., MD, Martin W., MD, Journal of Neurosurgery 81: , 1994 ABSTRACT Effects of Vertebral Axial Decompression On Intradiscal Pressure. Ramos G., MD, Martin W., MD, Journal of Neurosurgery 81: 350353, 1994 ABSTRACT The object of this study was to examine the effect of vertebral

More information

CURRICULUM VITAE. SPR in Neurosurgery North Thames Rotation Scheme. 1. Royal Free Hospital RFH ( ; 18 months ) Specialist Registrar

CURRICULUM VITAE. SPR in Neurosurgery North Thames Rotation Scheme. 1. Royal Free Hospital RFH ( ; 18 months ) Specialist Registrar CURRICULUM VITAE Name Title Present Position Address : -Jesus Lafuente : -MD, FRCSEd, PhD : -CONSULTANT NEUROSURGEON : -HOSPÌTAL DEL MAR PASEO MARITIMO 23 BARCELONA 08003 E-mail : jlbspine@gmail.com Phone

More information

Surgical treatments in severe IIH

Surgical treatments in severe IIH Surgical treatments in severe IIH You will have been told by your Doctor that you need to have a surgical procedure for Idiopathic Intracranial Hypertension. This may be because all the other treatments

More information

Stab wound of the neck: potential pitfalls in management

Stab wound of the neck: potential pitfalls in management Archives of Emergency Medicine, 1989, 6, 225-229 CASE REPORT Stab wound of the neck: potential pitfalls in management R.D. PAGE &R.H. LYE University Department of Neurosurgery, Manchester Royal Infirmary,

More information

S ome hydrocephalic patients with extracranial shunts

S ome hydrocephalic patients with extracranial shunts PAPER Quantitative analysis of continuous intracranial pressure recordings in symptomatic patients with extracranial shunts P K Eide... Competing interests: none declared... Correspondence to: Dr Per Kristian

More information

WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE

WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE WHITE PAPER: A GUIDE TO UNDERSTANDING SUBARACHNOID HEMORRHAGE Subarachnoid Hemorrhage is a serious, life-threatening type of hemorrhagic stroke caused by bleeding into the space surrounding the brain,

More information