The effect of whole body position on lumbar cerebrospinal fluid opening pressure.

We compared cerebrospinal fluid (CSF) opening pressure measurements in the lumbar subarachnoid space between the flexed position (F-OP) and relaxed position (R-OP) in recumbent patients. We devised an equation for using F-OP to determine the existence of raised intracranial pressure (ICP). Patients (n = 83) underwent lumbar puncture while in the flexed lateral decubitus position and then were moved to the relaxed position. F-OP and R-OP were measured with a water manometer. R-OP > 180 mmH2O plus relevant clinical signs were taken as indicators of raised intracranial pressure. Mean pressures for F-OP and R-OP were 178.54 and 160.52 mmH2O respectively, p <0.001. When F-OP > 180, raised ICP could be significantly over diagnosed. The authors recommend an equation [R-OP(calculated, mmH2O) = 0.885 x F-OP(measured, mmH2O)] or using 200 mmH2O as the threshold for increased ICP with flexed posture.

Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study.

OBJECTIVE: To compare the prevalence of Post Dural Puncture Headache (PDPH) between 6 hour- supine recumbence and early ambulation in Thai patients. MATERIAL AND METHOD: The present study was a prospective controlled study and enrolled the patients who underwent Lumbar Puncture (LP) from Phramongkutklao Hospital, Thailand. The background characteristics were recorded Standard LP method was done. The patients were randomized to 6 hour-supine recumbence and < or = 1 hour- (early ambulation) groups. Prevalence and characteristics of PDPH were compared. RESULTS: Of 65 patients, there were 33 patients (50.8%) in the 6 hour-recumbent group and 32 patients (49.2%) in the early ambulation group. The background characteristics and CerebroSpinal Fluid (CSF) findings were not different between the groups. Prevalence of PDPH was 16.9% (overall), 18.2% (6 hours) and 15.6% (early ambulation). There was no statistically significant difference in prevalence, pattern and severity of PDPH between the groups. CONCLUSION: The prevalence and characteristics of PDPH were not different between the 6 hour- recumbence and early ambulation groups.