Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients |
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Authors: | M Strupp T Brandt A Müller |
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Institution: | Department of Neurology, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Marchioninistra?e 15, D-81366 Munich, Germany e-mail: mstrupp@nefo.med.uni-muenchen.de Tel.: +49-89-7095-2571 Fax: +49-89-7095-8883, DE Department of Neurosurgery, University of Munich, Klinikum Grosshadern, Munich, Germany, DE
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Abstract: | The post-lumbar puncture syndrome (PLPS) can best be explained by prolonged spinal fluid leakage owing to delayed closure
of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagnostic lumbar puncture (LP). This difference
could be caused by a strand of arachnoid, which might enter the needle with the outflowing cerebrospinal fluid (CSF) during
diagnostic LP and upon removal of the needle be threaded back through the dura to produce prolonged CSF leakage. To find a
technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting
the stylet before removing the needle had on the incidence of PLPS. By reinserting the stylet to the tip of the needle, the
hypothesized strand would be pushed out, thereby reducing the frequency of PLPS. Sprotte’s “atraumatic needle” (21 gauge)
was used for LP. A total of 600 patients participated in the prospective study. They were randomized into two groups and questioned
about their complaints every day for up to 7 days after the LP. All LPs were performed by two experienced neurologists (T.B.,
M.S.). In 300 patients, the stylet was reinserted to the tip of the needle; in the other 300 it was not reinserted. Whereas
49 of the 300 patients without reinsertion developed PLPS, only 15 of the 300 patients with reinsertion did. This significant
difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basis of our results, we recommend reinserting the stylet before
removing the needle in order to reduce the incidence of PLPS.
Received: 30 September 1997 Received in revised form: 9 March 1998 Accepted: 20 March 1998 |
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Keywords: | Post-lumbar puncture syndrome Post-lumbar puncture headache “ Sprotte’ s atraumatic needle” Stylet |
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