The Queckenstedt Test

The determination of the spinal fluid dynamics is a common procedure used whenever disease of the spinal cord is suspected and particularly when there is clinical evidence of an obstructive lesion. Actually, it consists in the testing of the free transmission of pressure along the spinal subarachnoid space. The value of the test depends largely upon the accuracy and skill with which it is performed. Inasmuch as the nurse is frequently called upon to assist in the procedure, it is important that she understand the basic anatomical and physiological principles involved. The method described below is essentially that of Grant and Cone,' but with certain modifications. Principle: The cerebrospinal fluid, originating presumably from the choroid plexus, circulates through the ventricles and subarachnoid spaces and is absorbed eventually into the major intracranial venous sinuses. The greater part of the venous return from the head is through the jugular veins. Thus, any obstruction to the free flow of blood in the jugular veins causes distention of the intracranial venous channels with a consequent rise in intracranial pressure. This rise in pressure is reflected in the lumbar subarachnoid space in the absence of an obstruction above this level. Also, the degree of pressure rise in the subarachnoid space is proportional to the degree of pressure exerted upon the jugular veins. By means of graded pressures applied to the jugular veins in the neck and with a needle inserted into the lumbar subarachnoid space, the presence and degree of an intraspinal obstruction can be determined. Such graded pressures can be applied conveniently, as suggested by Grant and Cone, by means of a blood-pressure cuff applied about the neck. This method is quantitative and has advantages over the method of digital compression of the jugulars. It is particularly suited to graphic representation (Figs. 1A and 1B). Method: The equipment is that needed for the usual lumbar puncture and, in addition, a sphygmomanometer, a watch with a