van Crevel H, Hijdra A, de Gans J
Academic Medical Centre, Department of Neurology, Amsterdam, The Netherlands.
J Neurol. 2002 Feb;249(2):129-37. doi: 10.1007/pl00007855.
Death following lumbar puncture (LP) is feared by physicians. Many opinions are found in literature on the question whether computed cranial tomography (CT) should be performed before LP, to prevent herniation. These opinions are mainly based on retrospective studies and pathophysiological reasoning. In this review the difficulties in the decision whether we should perform CT before LP are discussed. It is explained that the concept of "raised intracranial pressure" is confusing, and that the less ambiguous terms "brain shift" and "raised CSF pressure" should be used instead. Brain shift is a contraindication to LP, whether CSF pressure is raised or not, and whether papilloedema is present or not. Subsequently, recommendations are offered for indications to perform CT before LP, grouped according to the safety and clinical utility of LP.
腰椎穿刺（LP）后死亡是医生们所担心的。关于在腰椎穿刺前是否应进行头颅计算机断层扫描（CT）以预防脑疝，文献中有很多观点。这些观点主要基于回顾性研究和病理生理推理。在这篇综述中，讨论了在腰椎穿刺前是否进行CT检查这一决策中的困难。文中解释了“颅内压升高”这一概念令人困惑，而应使用不太模糊的术语“脑移位”和“脑脊液压力升高”来替代。无论脑脊液压力是否升高，无论是否存在视乳头水肿，脑移位都是腰椎穿刺的禁忌证。随后，根据腰椎穿刺的安全性和临床实用性，对腰椎穿刺前进行CT检查的指征提出了建议。
