Procedure:
(1) Perform a lumbar puncture and measure the CSF pressure.
(2) Remeasure the pressure while compressing one or both jugular veins.
(3) A final pressure reading is taken after the pressure on the veins is released.
Normally there is a prompt rise as long as jugular vein compressed and a prompt return to normal after the pressure is stopped. Compression of both jugular veins causes a higher pressure than if only one is compressed
The presence of a blockage between the jugular vein and the CSF results in no change in pressure or else a delay in the pressure rise and fall.
Differential diagnosis of an abnormal test:
(1) If the response is abnormal when one jugular vein is compressed but not the other, then suspect a sinus thrombosis on the same side.
(2) If the response is abnormal when both jugular veins are compressed, then there is a block in CSF flow.
(3) A block of the needle point by a nerve root.
The "Reverse Test" involves compressing the abdomen while measuring the CSF pressure. In the event of a true block in CSF flow, the pressure will increase when the abdomen is pressed, due to congestion of the intraspinal veins below the level of the block. If there is a prompt rise in the pressure on abdominal compression, then the needle is not blocked.
Contraindications for performing the Queckenstedt test:
(1) intracranial bleeding
(2) intracranial tumor
