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Interpretation of lumbar puncture opening pressure measurements in children

Robert A Avery1

  • 1Departments of Neurology, Ophthalmology, Pediatrics, The Gilbert Family Neurofibromatosis Institute, Center for Neuroscience and Behavior (RAA), Children's National Health System, Washington, District of Columbia.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|August 19, 2014
PubMed

Insights

A normal cerebrospinal fluid opening pressure (CSFOP) for most children is 28 cm H2O or less. This measure, along with clinical findings, aids in diagnosing elevated intracranial pressure in pediatric patients.

Area of Science:

  • Pediatric Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Establishing normal reference ranges for cerebrospinal fluid opening pressure (CSFOP) in children is critical for diagnosing elevated intracranial pressure (ICP).
  • Recent research emphasizes the importance of considering various clinical factors when interpreting CSFOP measurements.

Observation:

  • CSFOP measurements up to 28 cm H2O are generally considered normal for the pediatric population.
  • Factors like sedation depth, body mass index, and specific sedation medications can cause minor elevations in CSFOP.
  • Patient age and leg positioning (flexed or extended) in the lateral decubitus position do not appear to significantly influence CSFOP readings.

Findings:

  • A CSFOP threshold of ≤28 cm H2O is proposed as a general guideline for normal pediatric values.
  • Sedation, BMI, and medications are identified as potential confounders for CSFOP.
  • Age and leg position are not significant determinants of CSFOP.

Implications:

  • The interpretation of normal CSFOP values requires a holistic approach, integrating clinical and examination findings.
  • Physicians must consider CSFOP in conjunction with other data to accurately assess for elevated intracranial pressure in children.
  • This guideline aids in refining diagnostic accuracy for pediatric intracranial pressure assessment.
Abstract

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