Rethinking lumbar puncture safety: pathophysiology, diagnostic uncertainty, and research gaps in herniation risk

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F61383082%3A_____%2F25%3A00001577" target="_blank" >RIV/61383082:_____/25:00001577 - isvavai.cz</a>

Výsledek na webu

<a href="https://pubmed.ncbi.nlm.nih.gov/40804214/" target="_blank" >https://pubmed.ncbi.nlm.nih.gov/40804214/</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1007/s13760-025-02866-0" target="_blank" >10.1007/s13760-025-02866-0</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Rethinking lumbar puncture safety: pathophysiology, diagnostic uncertainty, and research gaps in herniation risk

Popis výsledku v původním jazyce

Lumbar puncture (LP) is a key diagnostic and therapeutic tool, yet concerns persist about its potential to induce brain herniation, especially in patients with elevated intracranial pressure (ICP). Despite ongoing debate, precise risk factors and pathophysiological mechanisms remain unclear. Objective: This systematic review aims to examine the risk of cerebellar and paradoxical brain herniation following LP, evaluate the current evidence regarding its incidence, and discuss the implications for clinical practice as well as show the gaps in research. Methods: Following PRISMA guidelines, a systematic literature review was conducted using the PubMed (MEDLINE) database. Studies from 1990 to 2024 focusing on bacterial meningitis, idiopathic intracranial hypertension, post-surgical states, and other conditions associated with elevated ICP were included. Results: LP-related herniation was reported in diverse clinical settings, with cerebellar herniation primarily seen in bacterial meningitis and idiopathic intracranial hypertension. Herniation onset varied from minutes to days post-LP. While cranial CT is widely used for risk assessment, its predictive accuracy is debated. Conclusions: Although LP is relatively safe, herniation risk is highly context-dependent. Clinicians should integrate clinical, radiological, and pathophysiological factors in decision-making. Further research is needed to refine predictive models and establish evidence-based guidelines for high-risk patients.

Název v anglickém jazyce

Rethinking lumbar puncture safety: pathophysiology, diagnostic uncertainty, and research gaps in herniation risk

Popis výsledku anglicky

Lumbar puncture (LP) is a key diagnostic and therapeutic tool, yet concerns persist about its potential to induce brain herniation, especially in patients with elevated intracranial pressure (ICP). Despite ongoing debate, precise risk factors and pathophysiological mechanisms remain unclear. Objective: This systematic review aims to examine the risk of cerebellar and paradoxical brain herniation following LP, evaluate the current evidence regarding its incidence, and discuss the implications for clinical practice as well as show the gaps in research. Methods: Following PRISMA guidelines, a systematic literature review was conducted using the PubMed (MEDLINE) database. Studies from 1990 to 2024 focusing on bacterial meningitis, idiopathic intracranial hypertension, post-surgical states, and other conditions associated with elevated ICP were included. Results: LP-related herniation was reported in diverse clinical settings, with cerebellar herniation primarily seen in bacterial meningitis and idiopathic intracranial hypertension. Herniation onset varied from minutes to days post-LP. While cranial CT is widely used for risk assessment, its predictive accuracy is debated. Conclusions: Although LP is relatively safe, herniation risk is highly context-dependent. Clinicians should integrate clinical, radiological, and pathophysiological factors in decision-making. Further research is needed to refine predictive models and establish evidence-based guidelines for high-risk patients.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30103 - Neurosciences (including psychophysiology)

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Acta Neurologica Belgica

ISSN

0300-9009

e-ISSN

—

Svazek periodika

2025

Číslo periodika v rámci svazku

Aug 2025

Stát vydavatele periodika

BE - Belgické království

Počet stran výsledku

12

Strana od-do

1-12

Kód UT WoS článku

001549118000001

EID výsledku v databázi Scopus

2-s2.0-105013339543