Basically my mother had Listerial Meningitis 15 years ago. Recently she met with the doctor who treated her (unrelated issues, not relelvant here). He mentioned some stuff that I do not understand and I seek the collective wisdom of the boards.
38CM pressure. This is what she had during the worst part of the meningitis. It is apparently A Very Bad Thing and was the reason he gave her a 1/3 chance of survival.
What does it mean, in layman’s terms?
Dad said that when she had a lumbar puncture, the fluid hit the ceiling.
WTF??? How can that even happen? Isn’t the whole needle, sample bottle etc self-contained to prevent further contamination of the spinal fluid?
According to family legend; The clinic doc she initially saw gave her antibiotocs ‘just in case’ before sending her up to the hospital. There was no bacterial agent found (masked by the antibiotocs), she was treated for viral meningitis, which allowed the listeria to build up again, making everything worse.
Possible? Likely?
Her doctor was rapt to see her, he considers her one of his miracle recoveries and was happy to chat about it all (hence the thread). After 15 years, she’s in much better shape than the last time he saw her! We’re pretty damned pleased that she made a full recovery, too. Apart from the odd headache when under stress, she’s had no ongoing issues from the illness.
It’s a measure of the pressure of cerebrospinal fluid on the meninges. What’s that mean…it means that because of her infection, her body made too much fluid to comfortably fill the tissue that normally covers the brain and spinal cord. It’s not very stretchy material, and it’s surrounded by inflexible bone. Because her body kept making fluid, but there was no more room for it, the pressure built up. 8-21 is considered normal, but some people think that should be changed to 6-20. 25 can be listed as normal if the patient is very obese in some reference materials. 38 is holy shit that’s high. In layman’s terms.
Since the fluid is coming out, it’s not likely that bacteria will swim upstream and further contaminate the spinal fluid. Plus, of course, the needle and gloves are sterile and the skin has been wiped with antibacterial stuff. So there shouldn’t be any external bacteria to contaminate the area anyhow. There may be something in the air, but that’s why you sign a consent. Infection is a risk, but a small one.
If the fluid is under extremely high pressure, then yes, it can spurt quite a distance.
I believe so, yes. At least, for urine and sputum (cough) samples, they want us to collect the sample before we start antibiotics, because if we don’t the culture might not grow. If the antibiotics are doing their job, the bacteria in the sample won’t grow. I believe it’s the same for CSF samples.
“Hit the ceiling” is probably a figure of speech, though. It’s done with the patient on her side if you’re measuring the pressure. So it probably wasn’t aimed toward the ceiling. It may have soaked the doctor’s labcoat, though.
Dad was allowed to stay and hold her hand for the LP, and that was his observation. Mum says she remembers having it done (pain on pain) and they both say she was face down. Whether that was specific for her, local to the hospital or old fashioned procedure (mid/late 1997), I don’t know. She says they gave her general anasthetic halfway through, he says she just passed out - :rolleyes:again.
I worked two years in an abattoir, nothing I saw there made my spine try to *clench *like that video did! The needle went so very far in … and then a little more.
Oh, and I just want to clarify that we’re very happy that the clinic doc gave her the antibiotics, the hospital admission staff said they ‘lost her’ three times (but got her back) before they could get her into ICU. If she hadn’t had that shot, they (told us later) might not have had the chance.
Been a weird couple of days having all this come back at us after so long.
Listeria meningitis is an uncommon and unusual form of meningitis. I say “unusual” because unlike the dramatic and often fulminant illness encountered when dealing with other types of bacterial meningitis, Listeria meningitis can be rather insidious and subtle. Likewise, the findings in the LP fluid in cases of Listeria meningitis are also often less dramatic. Furthermore, and again unlike other bacterial meningitis, the LP findings in Listeria are not just “quieter”, they are of a different character in general (for the medically inclined, I am referring to the fact that Listeria meningitis often shows a mononuclear cell CSF pleiocytosis (i.e. lymphocytes), relatively low CSF protein, and a CSF glucose that may be normal). In other words, even in the absence of prior antibiotic treatment, Listeria meningitis can be a tough diagnosis to make - its LP fluid features are not the “classic” ones you get with, say, Meningococcus. They often more closely resemble those of prior antibiotic treated bacterial meningitis or viral meningitis (see below).
To repeat, the LP findings of Listeria meningitis are very similar to the LP findings in people suffering from classic bacterial meningitis but who received prior antibiotic treatment.
In general, when someone is suspected of having meningitis, but they have received antibiotics recently, all bets are off when it comes to interpreting the LP results. The antibiotic treatment can mask the typical LP fluid findings of bacterial meningitis. Likewise, if the LP findings are milder than one might have expected given the overall clinical picture, then you have to consider that the person may have received antibiotics and thus, as a result, their LP fluid may not show the expected findings of the more usual bacterial meningitis.
Again, the LP fluid findings in Listeria meningitis may resemble those found in antibiotic treated bacterial meningitis. So, your mom’s LP results may have been what they were even without having had prior antibiotics.
It’s even more complicated - viral meningitis, usually a benign illness, gives LP fluid results that may be quite similar to those found in Listeria meningitis and to those found in prior antibiotic treated bacterial meningitis.
All these potentially confusing LP fluid findings, when coupled with the potential for catastrophe in untreated, or inappropriately treated, meningitis, often mandates that one treat the patient as if they had the worst type (bacterial) until all the results are back (and, even then, it may not be clear). Phrased differently, when one knows that the patient had antibiotics recently, or even is suspected of such, we often treat for bacterial meningitis, assuming that the LP fluid results have been altered by the anitbiotics.
Bottom line in your mother’s case, in my opinion, is that even without having received prior antibiotic treatment, her LP fluid findings (i.e those of Listeria) may not have been much different than if she hadn’t received any antibiotics.
(On re-reading, I am not happy that I’ve explained things very well. But, I am too tired to try again and wanted to at least post something now before I go to sleep).
Unless the ceiling was 37cm above your mother the fluid couldn’t have hit it!
Generally if you are going to measure opening pressures during spinal tap, the patient is lying on her side and the measuring tube is pointed straight up (it is a measure of height after all!)
Also for suspected cases of meningitis the current recommendation is to give antibiotics immediately if there will be an delay in acquiring the spinal fluid (ie if you’re going to get a CT scan first).
As for the negative culture, it’s also possible that they didn’t use conditions that are appropriate to detect Listeria. It’s not the easiest bug to culture and it’s not at the top of the list for bacterial causes of meningitis. Your family is lucky the doc caught it in time.
Depends how thin the leak stream is. If the measure stream is wider than the leak stream, the leak stream will have greater pressure and distance. Simple hydraulics.
Of course. That also makes perfect sense. Phew, everybody can be right. We’ve been on a bit of an emotional roller coaster. This whole thing has been bringing up all sorts of memories for us and what factual grip we can get is very much appreciated by us all.
If the OP doesn’t mind, isn’t encephalitis also dx’d with a lumbar puncture? I’ve always wondered how they tell the difference between encephalitis, meningitis or both(?).
No sorry, the leak stream is pointed in a different direction from the measure stream. See Figure 4 on this site. Basically you put the needle into the subarachnoid space parallel to the floor and then attach a three way valve with the measuring tube pointed toward the ceiling. See this close up picture.
Encephalitis generally includes all the same findings as meningitis plus altered mental status.
FYI: Listeria meningitis is much more common in neonates than it is in adults and requires the use of Ampicillin. This is standard treatment in children less than 1 month old who have any fever and in some children less than 3 months old depending on other history. It is not standard in adults with suspected bacterial meningitis.
Deltasigma, go for it. I’m happy to open this up for any other questions.
USCDiver, I don’t know. It fits with what Dad saw and they both remember. It doesn’t make sense to me that mum was face down, but it’s not going to achieve anything to tell them it didn’t happen that way. We can always put it down to a small town hospital using a non-standard procedure and getting weird results. My SIL was scathing about a few things they did ‘wrong’ (i.e. not like they did it when *she *was training).
cmyk, I know how you feel. Mine is available as a spare, she gives good hugs.
