(thus presumably has been normal since the EVD was removed) =YES,

hydrocephalus treated with an EVD, hydrocephalus now well treated and EVD out = EVD was progressively challenged and removed 

no overt symptoms of brain stem compression listed or given (clinical, neuro, vitals, etc.)= CLINICAL NEURO - NO CHANGE= GCS E4M6V4= SINCE SHE IS OUT OF ITU IN THE WARD FOR 3 DAYS NOW.

What is being used to measure the ICP? Subarachnoid bolt? JUST EVD HEIGHT IN NITU, GCS 14-13 SO ICP BOLT NOT INSERTED

Other clinical, neurological, and data that could be used to better assess the situation? Is the patient on any protocols, medications, etc, to restrict ICP (i.e., hyperosmotic therapies?). RECEIVED TRIPPLE H ON POST COILING DAY 5 FOR MILD WEAKNESS RIGHT ARM, IMPROVED ON DAY 7

Was the initial HCP non obstructive and associated with post-aneurysmal debris and cells, or the same but also a bleed into the ventricular system, or a mass of any kind blocking distal outflow? COMMUNICATING AS SHE HAS HAD 1 LP IN ITU ITSELF. ON DAY 20. MINIMAL DEBRIS, OPENING PRESSURE WAS 25 AND CLOSING PRESSURE 20, 25 ML CSF DRAINED

Has anything been tried to treat the ICP prior to the LP?  serum CHEMISTRY normal, no systemic infection, 

Thanks prof for asking these questions my answers are next to your questions.

i  leave the last 2 questions for you to elaborate...

Is it safe to presume the LP is being done to 1) provide a second ICP measure and 2) to create small holes in the lumbar dura to help CSF outflow? 

PATIENT IS IN THE WARD, GCS 14, ONLY COMPLAINT HEADACHE AND RAISED BP. no bradycardia, no new neurodeficit. wound site healthy no tenderness, no DVT.

I think it would be prudent to get a CT scan before an LP. I'm not clear on the indication for the LP? I would not rely on a lumbar dural hole to control ICP.

Definitely in the above settings only CT is preferred. I could see no indications for LP whatsoever you may expect as the reason for ICP or as a treating modality.

Patient seems to have raised ICP due to hydrocephalus. I think there is no need to do a lumbar puncture. A ventric tap to rule out ventriculitis may be indicated. If no infection then ventroculoperitoneal shunt may be done

Thanks.

Definitely a subtle point of disagreement: would you do a ventric tap on a patient when a ventrculitis can be diagnosed on LP?

Although u might consider a ventric tap in a non- communicating or localised ventriculitis? 

A small spike in anxiety to shift this patient to ITU from the ward has already been pointed out by Christopher Daniel Duntsch! Also he probably meant another LP when he said LUMBAR DURAL HOLES, unless He has evidence.

http://www.nlm.nih.gov/medlineplus/ency/article/001068.htm