Innovations In Clinical Neuroscience

JAN-FEB 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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15 ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 L E T T E R S T O T H E E D I T O R that the smaller needles are safe and that adequate amount of fluid can be collected. 9 Physicians will require additional training using this method, however. Comment. Pneumocephalus, though a rare complication of LP, has increased recently in frequency. The occurrence of a pneumocephalus after a diagnostic or therapeutic LP procedure might worsen a presenting condition and might also lead to complications, such as a tension pneumocephalus. Pneumocephalus induced by an LP often resolves without intervention; conservative measures include bed rest, head elevation, avoidance of positive pressure, and pain control. During an LP, consider utilizing a smaller sized spinal needle to minimize this complication. REFERENCES 1. Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review. Neurocrit Care. 2010;13(1):152–158. 2. Flora GS, Tuchschmid JA, Sharma OP. Pneumocephalus in association with lumbar punctures. Chest. 1990;98(4):1041. 3. Kozikowski GP, Cohen SP. Lumbar puncture associated with pneumocephalus: report of a case. Anesth Analg. 2004;98(2):524–526. 4. Nelson AS, Jafari A, Shah P, et al. Pneumoencephaly following lumbar puncture in association with an ethmoidal osteoma and porencephalic cyst. J Neurol Neurosurg Psychiatry. 2007;78(10):1149–1151. 5. Girauda P, Chauvet S. Secondary pneumocephalus after lumbar puncture: An unusual complication of spontaneous intracranial hypotension? Clin Neurol Neurosurg. 2013;115(10): 2204–2206. 6. Tran P, Reed EJ, Hahn F, et al. Incidence, radiographical features, and proposed mechanism for pneumocephalus from intravenous injection of air. West J Emerg Med. 2010;11(2):180–185. 7. O'Connor G, Gingrich R, Moffat M. The effect of spinal needle design, size, and penetration angle on dural puncture cerebral spinal fluid loss. Am Assoc Nurse Anesthetists J. 2007;75(2):111–116. 8. Zorrilla - Vaca A, Healy R, Zorrilla - Vaca C. Finer gauge of cutting but not pencil point needles correlate with lower incidence of post dural puncture headache: a meta regression analysis. J Anesth. 2013. Doi: 10.1007/s00540- 016-2221-2. 9. Bertolotto A, Malentacchi M, Capobianco M, et al. The use of the 25 Sprotte needle markedly reduces post-dural puncture headache in routine neurological practice. Cephalalgia. 2016;36(2):131–138. With regard, Murali K. Kolikonda, MD; Priyanga Jayakumar, MD; Srividya Sriramula, MD; and Steven Lippmann, MD Dr. Kolikonda is from the Department of Neurology, Dr. Jayakumar is from the Division of Infectious Diseases, Dr. Sriramula is with Internal Medicine, and Dr. Lippmann is from the Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky. Correspondence: Steven Lippmann, MD; Email: Funding/disclosures: No funding was provided. The authors have no conflicts of interest relevant to the content of this letter. ICNS FIGURE 1. Axial tomography of the brain revealing an air bubble in the middle cranial fossa

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