A cisternogram, also known as a cerebrospinal fluid (CSF) flow scan, is a test in which the radiopharmaceutical 111In-DTPA is injected intrathecally during a lumbar puncture and is a sensitive indicator of altered flow and reabsorption of CSF. Congenital malformations are the most common causes of hydrocephalus in the neonate. In older patients and in cases of trauma, CT or MRI is often used to identify anatomic origins of obstructive hydrocephalus. In the treatment of hydrocephalus, this test aids in selection of the type of shunt and pathway and in determining the prognosis of both shunting and hydrocephalus.
Perform a sterile lumbar puncture after the patient has been positioned and prepared (see Chapter 5 for lumbar puncture procedure). Inject the radionuclide into the cerebrospinal circulation.
Have the patient lie flat after the puncture (usually 1 hour); the length of time depends on the practitioner’s order.
Perform imaging 4 hours after injection and repeat after 24, 48, and 72 hours if the healthcare provider so directs.
Advise the patient that examination time is about 1 hour for each imaging.
See Chapter 1 guidelines for safe, effective, informed intratest care.
Abnormal filling patterns reveal:
Cause of hydrocephalus (e.g., trauma, inflammation, bleeding, intracranial tumor)
Subdural hematoma
Spinal mass lesions
Posterior fossa cysts
Parencephalic and subarachnoid cysts
Communicating versus noncommunicating hydrocephalus
Shunt patency
Diagnosis and localization of rhinorrhea and otorrhea
Pretest Patient Care
Explain the purpose, procedure, benefits, and risks of both lumbar puncture and cisternography. Tell the patient to not eat or drink anything for at least 8 hours before the test.
Refer to standard NMI pretest precautions.
Advise the patient that it may take as long as 1 hour for each imaging session.
Because of the lumbar puncture, transport the patient by cart to the nuclear medicine department for the first imaging session.
Follow guidelines in Chapter 1 for safe, effective, informed pretest care.
Posttest Patient Care
Follow instructions for lumbar puncture (see Chapter 5) and standard NMI posttest precautions.
Be alert to complications of lumbar puncture, such as meningitis, allergic reaction to anesthetic, bleeding into spinal canal, herniation of brain tissue, and mild to severe headache.
Review test results; report and record findings. Modify the nursing care plan as needed.
Follow guidelines in Chapter 1 for safe, effective, informed posttest care.