Table of Contents

HK J Paediatr (New Series)
Vol 14. No. 1, 2009

HK J Paediatr (New Series) 2009;14:22-28

Personal Practice

Potential Risk of Fatal Cerebral Herniation After Lumbar Puncture in Suspected CNS Infection
疑患神經系統感染患者進行腰椎穿刺後出現致命性腦疝的潛在危險

KL Kwong, WK Chiu


Abstract

Lumbar puncture is important in the investigation of suspected CNS infection. However, there is genuine concern and controversy about the risk of cerebral herniation after lumbar puncture. CT scan brain is widely performed before lumbar puncture whenever raised intracranial pressure is suspected. The pros and cons of interposition of CT scanning before lumbar puncture pose a clinical dilemma and have led to confusion among paediatricians and even a delay in initiation of therapy. CT scan brain only provides structural information and is considered insensitive in the exclusion of raised intracranial pressure. Clinical signs, not a CT scan brain, are the best indicators of when to or when not to do lumbar puncture. To exercise caution, relevant questions need to be addressed before performing a lumbar puncture. Literature is reviewed regarding lumbar puncture and cerebral herniation. The aim is to formulate a rational approach in managing children with suspected CNS infection.

腰椎穿是疑患神經系統感染的一項重要檢查。然而,腰椎穿後發生腦疝的危險是一個確實存在的擔憂與爭議。如果懷疑顱內壓增高,腰椎穿前,已廣泛進行腦CT掃描。贊成與反對腰椎穿前進行CT掃描的爭論,使臨床醫生處於進退兩難的窘境,使兒科醫生難下決定,甚至延誤了初期治療。檢查與批評了病例治療時的決策過程。提請注意,腰椎穿前相關問題處理的需要。綜述了有關腦疝及腰椎穿文獻。本文目的在於討論一種合理的措施治療疑患神經系統感染的兒童。

Keyword : Cerebral herniation; Children; Lumbar puncture

關鍵詞:腦疝、兒童、腰椎穿

 
 

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