The effect of whole body position on lumbar cerebrospinal fluid opening pressure

Pasiri Sithinamsuwan; Nakorn Sithinamsuwan; Sirakarn Tejavanija; Chesda Udommongkol; Samart Nidhinandana

doi:10.1186/1743-8454-5-11

The effect of whole body position on lumbar cerebrospinal fluid opening pressure

Cerebrospinal Fluid Res. 2008 Jul 2:5:11. doi: 10.1186/1743-8454-5-11.

Authors

Pasiri Sithinamsuwan¹, Nakorn Sithinamsuwan, Sirakarn Tejavanija, Chesda Udommongkol, Samart Nidhinandana

Affiliation

¹ Division of Neurology, Phramongkutklao Hospital and College of Medicine, Bangkok, 10400, Thailand. pasiripmk@gmail.com.

Abstract

We compared cerebrospinal fluid (CSF) opening pressure measurements in the lumbar subarachnoid space between the flexed position (F-OP) and relaxed position (R-OP) in recumbent patients. We devised an equation for using F-OP to determine the existence of raised intracranial pressure (ICP). Patients (n = 83) underwent lumbar puncture while in the flexed lateral decubitus position and then were moved to the relaxed position. F-OP and R-OP were measured with a water manometer. R-OP > 180 mmH2O plus relevant clinical signs were taken as indicators of raised intracranial pressure. Mean pressures for F-OP and R-OP were 178.54 and 160.52 mmH2O respectively, p <0.001. When F-OP > 180, raised ICP could be significantly over diagnosed. The authors recommend an equation [R-OP(calculated, mmH2O) = 0.885 x F-OP(measured, mmH2O)] or using 200 mmH2O as the threshold for increased ICP with flexed posture.