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  • 1
    ISSN: 1432-1459
    Keywords: Key words Post-lumbar puncture syndrome ; Post-lumbar puncture headache ; “Sprotte’s atraumatic ; needle” ; Stylet
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1459
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Magnetresonanztomographie ; Computertomographie ; Felsenbein ; Schwindel ; Benigner peripherer paroxysmaler Lagerungsschwindel ; Neuritis vestibularis ; Vestibularisparoxysmie ; Cogan-Syndrom ; Key words Vertigo ; Vestibular neuritis ; Benign paroxysmal positioning vertigo ; Bilateral vestibulopathy ; Menière’s disease ; Traumatic vertigo ; Cogan’s syndrom ; Vestibular paroxysmia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary High resolution magnetic resonance imaging (HR-MRI) and computed tomography (HR-CT) of the inner ear are becoming more important for the diagnosis of peripheral vestibular lesions. Modern HR-MRI techniques allow visualization of detailed anatomic features of the vestibulo-cochlear regions as well as pathologic findings in the inner ear such as, neoplastic lesions (e.g., small intracanalicular acoustic neuromas), anomalies causing vertigo and hearing loss (e.g. Mondini’ s-malformation, perilymph fistula, vestibular paroxysmia), and inflammatory diseases (e.g., Cogan’s syndrome, labyrinthitis, zoster neuritis). HR-CT is still the first examination that should be performed in patients with middle ear diseases (e.g., tumor, infection), trauma (e.g. temporal bone fractures), or fibro-osseous diseases. Although the imaging of the vestibulo-cochlear system has dramatically improved, there are still several peripheral vestibular disorders that cannot be visualized so far, e.g., benign paroxysmal positioning vertigo, idopathic vestibular neuritis or Menière’s disease.
    Notes: Zusammenfassung Mit Hilfe der hochauflösenden Magnetresonanztomographie und Computertomographie des Felsenbeins lassen sich aufgrund neuer methodischer Entwicklungen inzwischen folgende peripher-vestibulären Erkrankungen zuverlässig nachweisen: Raumforderungen im Kleinhirnbrückenwinkel, inneren Gehörgang (z.B. Akustikusneurinom), Mittelohr (z.B. Cholesteatom), ferner posttraumatische Schwindelformen durch Felsenbeinfrakturen sowie die „Pseudoneuritis vestibularis” durch faszikuläre Läsionen des N. vestibularis in der Eintrittszone in den Hirnstamm (MS-Plaques oder ischämische Läsionen). Wichtig ist die Bildgebung für die Diagnostik von entzündlichen (z.B. Labyrinthitis, Cogan-Syndrom), hereditären (z.B. Mondini-Alexander-Dysplasie) oder neoplastischen (z.B. Meningeosis carcinomatosa) Innenohrerkrankungen sowie der Vestibularisparoxysmie (durch Gefäß-Nerv-Kontakt), Labyrinthfistel, nichtidiopathischen Neuritis vestibularis (z.B. durch Herpes zoster) und Labyrinthkontusion. Der bildgebenden Diagnostik entziehen sich bislang noch der benigne periphere paroxysmale Lagerungsschwindel, der M. Menière und die idiopathische Neuritis vestibularis. In dieser Übersicht werden anhand vieler Fallbeispiele Möglichkeiten und Grenzen moderner bildgebender Verfahren bei der Diagnostik peripher-vestibulärer Erkrankungen mit dem Leitsymptom Schwindel aufgezeigt.
    Type of Medium: Electronic Resource
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