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From: B. Harris)
Subject: Re: Spinal tap Question
Date: 20 May 1999 18:31:25 GMT

In <7i17pc$> (cavebug) writes:

>time here's the question. Besides a hemorage in the brain what else can
>cause red blood cells to be present in the spinal fluid?? She was taking
>LOTS of asiprin and advil for the headache the prior three days and she
>also has a history of high blood pressure.

Depending on how much blood was there, it could be simple the result of
a messy tap which caused local bleeding in the subdural space.  If they
sent her home they obviously think the likelihood of a subarachnoid
hemorrhage (from a burst vessel or aneurism in the brain) is not very
high. Such a thing is true medical emergency, since the consequences
can be so devastating.

From: B. Harris)
Subject: Re: FOLLOWUP-: Spinal tap Question
Date: 22 May 1999 01:20:12 GMT

<5E6F79EB6A707B46.371B760BB9F169BA.9DF9E4E6E2883926@library-proxy.airne> (Jonathan R. Fox) writes:

>On Fri, 21 May 1999 14:39:23 GMT, (cavebug) wrote:
>>Just in case anyone might have wondered about the outcome, they kept her
>>in the hospital and continued to run tests. The CAT scan, MRI, and MRA
>>were all negitive and they're going to go ahead with an angiogram just
>>to be safe. I also found out that the spinal tap showed high levels of
>>red blood cells in the first tube with lesser amounts in the following
>Just curious -- what is unusual enough about her headache to warrant
>all these tests?
>Jonathan R. Fox, M.D.

   I'd like to know, also.  It's not as though iatrogenicus
laboratorius fulminans doesn't go on.

   A family member of mine recently sustained a severe facial fracture
in an athletic accident, and besides multiple other facial fractures,
also had cribiform plate fracture on MRI.  She was leaking clear fluid
from the nose.  I've seen this kind of thing before.  I asked the
nurses to test the fluid for glucose with a glucometer (cost--$2,
maybe).  CSF would have lots of glucose, mucus almost none.  I asked
the surgeon to do it.  I asked the neurologist to do it.  Nobody did
it.  The next day someone had the bright idea that to make sure it
wasn't CSF by doing a radiotracer scan in which Tc-99m is injected into
the lumbar subdural space and tracked to see if it shows up in the
sinuses.  Not surprisingly, it did.  Yes, it was CSF.  Cost: around
$800 and some pain.  Plus, the admission that with that much fluid
they'd probably have put in a lumbar decompression catheter, even if it
had come out negative, just to be sure.  Which they did.  What a
tremendous frigging waste of money.  Technology substuted for thinking,
just because it's harder to document thinking and we don't value it
anyway.  Due to the fact that most people are convinced they do it as
well as anybody else.

From: B. Harris)
Subject: Re: FOLLOWUP-: Spinal tap Question
Date: 25 May 1999 01:08:07 GMT

In <7ic2aa$> (cavebug) writes:

>Continous headache four four days, disorientation and confusion led to
>the emergency room. This then led to what appears to be a poorly done
>spinal tap which led to all the tests.

   The story of modern medicine, right.  Is the system set up so that
someone especially skillful at doing LPs, so as to save $3,000 worth of
fancy scans, is paid even a fraction of that, in acknowledgement of his
or her skill and ability to save money?  Nope.  So such people never
appear.  If there was a bounty of $1000 a pop on getting a crystal
clear tap on a person suspected of subarachnoid bleed, you can bet that
such people would appear.  A whole subspeciality would be created, in
fact. But the market does not opperate, and so we pay.  And pay.  And

   Other countries aren't any smarter about this.  They just limit the
number of scanners.  So some of their people who have small
subarrachnoid bleeds just don't get scanned-- it being assumed they
have a slightly bloody tap, when they do, due to poor technique or bad
luck.  Come back tomorrow of the next day if you're not better.  And
those people suffer the cerebral consequences.  But they're rare, so
tough bananas.  The system does anything, and will kill nearly anybody,
rather than pay people what a machine gets, if it's a lot of money.
Nobody's jealous of an MRI machine, you see.  Except possibly me.  (I
think the MRI scanner lifestyle is way overboard, and I've seen one too
many of the blasted things on Caribbean cruises with a girl on each
keyboard.  They seem to attract chicks like a magnet.)

>Now diagnosed with "cluster migraines".

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