Letter to the Editor: Pneumocephalus: Is the needle size significant?

Discussion. Pneumocephalus is defined by two mechanisms: a ball-valve and an inverted bottle concept.1 The ball-valve type implies positive pressure events, such as coughing or valsalva maneuvers, that prevent air escape. Tension pneumocephalus is included in this mechanism, causing a parenchymal mass effect. The inverted bottle theory includes a negative intracranial pressure gradient following cerebrospinal fluid drainage, relieved by air influx. A small pneumocephalus is usually sealed by blood clots or granulation, allowing spontaneous reabsorption and resolution.[1] Otherwise, the lateral positioning of a patient during spinal tap might create a lower intrathecal pressure with air being allowed into the subarachnoid space. Pneumocephalus also can develop when a stylet is reinserted into the needle before needle retraction, usually performed to minimize post-dural-puncture headache.[6] Pneumocephalus can be avoided by performing the LP in a sitting position, monitoring the amount of fluid drainage, carefully replacing the stylet to make sure the needle does not contain air, and instructing patients to briefly hold their breath and prevent making sudden movements during the procedure.[3] It is also important to consider needle size during a spinal tap. A smaller gauge makes a smaller dural perforation, causing less damage compared to larger ones; that also prevents cerebrospinal fluid leakage.[7,8] There is an inverse correlation between the needle gauge and post-dural-pun...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Assessment Tools CNS Infections Current Issue Letters to the Editor Neurologic Systems and Symptoms Neurology Stroke Traumatic Brain Injury epidural needle size Pneumocephalus spinal tap Source Type: research

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CONCLUSIONS: Perceived devaluation was extremely prevalent among street-involved youth in our sample. We also observed that youth most in need of health and social services were significantly more likely to report high levels of perceived devaluation which may result in a reluctance to seek out key services and supports. These findings highlight the need to implement stigma reduction interventions for vulnerable youth in this setting. PMID: 30526206 [PubMed - as supplied by publisher]
Source: Substance Use and Misuse - Category: Addiction Tags: Subst Use Misuse Source Type: research
Authors: Bennett A, Lepage C, Thavorn K, Fergusson D, Murnaghan O, Coyle D, Singh SS Abstract Traditionally, hysteroscopy has been performed in the main operating room with the patient under general anaesthesia. Hysteroscopy performed in an office setting avoids the risks of general anaesthesia. The aim of this review was to evaluate the effectiveness of outpatient hysteroscopy compared with hysteroscopy performed in the operating room to diagnose and/or treat intrauterine pathology. Relevant electronic databases were searched, including Medline, EMBASE, and the Cochrane Library. RCTs and nonrandomized studies that...
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
Authors: Yimer H, Woldie H Abstract The number of CS procedures has increased dramatically both in developed and developing countries in recent decades. CS has been associated with chronic pain. A vicious impediment on quality of life may occur among women who experience chronic post-CS pain (CPCSP). Therefore, this systematic review aimed to synthesize the available evidence on the incidence of chronic pain after Caesarean delivery and the possible risk factors for the development of chronic pain. The PubMed, Embase, and Google Scholar databases were searched for articles published in English between 2004 and Janu...
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
No 115 - Choc hémorragique. J Obstet Gynaecol Can. 2018 Dec;40(12):e883-e892 Authors: Martel MJ Abstract OBJECTIF: Passer en revue les aspects cliniques du choc hémorragique et formuler des recommandations pour son traitement. OPTIONS: La reconnaissance précoce du choc hémorragique et une intervention rapide et systématique aident à éviter des issues indésirables. RéSULTATS ATTENDUS: Formuler des directives cliniques pour aider à reconnaître rapidement le choc hémorragique et à pratiquer la réanimation ...
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
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Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
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Source: NeuroImage - Category: Neuroscience Source Type: research
Authors: Barbanti P, Grazzi L, Egeo G Abstract INTRODUCTION: Migraine is increasingly recognized as an extremely burdensome and disabling disorder in both children and adolescents. A proper treatment plan is needed to improve the quality of life of both children and families as well as to minimize the risk of disease progression. Areas covered: This review focuses on the current pharmacotherapy for acute migraine in pediatric populations, taking into account specific considerations for those drugs tested in randomized, placebo-controlled trials (RCTs). Expert opinion: A large number of RCTs have documented the effi...
Source: Expert Opinion on Pharmacotherapy - Category: Drugs & Pharmacology Tags: Expert Opin Pharmacother Source Type: research
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Source: Neurological Research - Category: Neurology Tags: Neurol Res Source Type: research
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Source: Results in Physics - Category: Physics Source Type: research
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Source: Results in Physics - Category: Physics Source Type: research
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