Lumbar puncture in patients with marked choked disk is dangerous, especially in cases with subtentorial tumor. In such cases combined ventricular and lumbar puncture1 is safer and gives added information. In doubtful cases with only slight or questionable choking of the disk, lumbar puncture, cautiously performed, is safe.
The cerebrospinal fluid pressure should be measured with a water manometer, the patient lying comfortably in an exact horizontal position. Procaine hydrochloride anesthesia should be used to avoid pain. A true pressure reading can be obtained only when the patient is fully relaxed. A false high pressure is most often due to emotional or physical tension. If the pressure is elevated, at least five minutes must be allowed for the patient to relax before a high pressure reading may be accepted as significant. Morphine and ether anesthesia raise the cerebrospinal fluid pressure.
A false low pressure may be caused either by
FREMONT-SMITH F. CEREBROSPINAL FLUID IN DIFFERENTIAL DIAGNOSIS OF BRAIN TUMOR. Arch NeurPsych. 1932;27(3):691–694. doi:10.1001/archneurpsyc.1932.02230150207011
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