S14C169 - CNS procedures and devices

Question 1

LP contraindications

Answer 1

• skin infxn over site
• CNS lesion causing increased ICP
• spinal mass
• platelets 50 are safe for LP but correct beforehand
• INR >1.5
• UFH or LMWH in past 24h
• hemophilia, vW dz
• trauma to lumbar vertebrae

Question 2

Shunt malfunction symptoms

Answer 2

• infants: bulging fontanelle, vomiting, irritibaility
• children/adults: cephalgia, n/v, lethargy, ataxia, CN palsy
• paralysis of upward gaze (Sundowning) occurs from third ventricle engorging
• dilated pupils, papilledema

Question 3

Shunt infxn:

Answer 3

• 1/2 occur in first 2w of placement
• 70% ocur w/in 2mo
• 80% occur w/in 6mo
• LP misses shunt infection often
• shunt tap required to dx
• tx: CTX, vanco