Normal Cerebrospinal Fluid Dynamics in Spinal Cord Tumor Suspects

As the result of the efforts of Ayer1and Stookey,2the technic of eliciting abnormal changes in cerebrospinal fluid dynamics has become so refined that an obstruction in the spinal canal can be detected earlier in the disease than formerly. Cases have been reported, however, in which tumors were found that appeared large enough to block the entire canal but normal dynamics were shown by lumbar puncture. The question therefore arises, What size must a tumor be in relation to the spinal canal before there are any demonstrable changes in dynamics? Patients have frequently been known to suffer from pains for years which were thought due to rheumatism, sciatica, sacro-iliac disease or neuritis, before any objective symptoms were detected to suspect an intraspinal lesion. In such instances a problem as to the value of a lumbar puncture always arises, especially when the tumor does not obliterate the subarachnoid