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LUMBAR PUNCTURE

Lumbar Puncture. (Spinal Tap) or an LP is a procedure to obtain a sample of cerebrospinal fluid (CSF).  Examination of the cerebrospinal fluid remains the most direct and accurate method to determine central nervous system infection.

INDICATIONS:
  • Suspected Central Nervous System Infection.  A cell count, gram stain, and bacterial cultures are essential.  Fungal cultures, acid fast bacilli and India ink studies are also useful.
  • Suspected Subarachnoid hemorrhage (note xanthochromia and RBC in the fluid).
  • Meningeal carcinomatosis.  Presence of cancer cells in the cerebrospinal fluid.
  • Gullian Barr'e Syndrome (in which a very high protein count is seen)
  • Multiple Sclerosis (elevated IgG is present on electrophoresis of the CSF).
  • Intrathecal antibiotics and Chemotherapeutics

CONTRAINDICATIONS:

  • Local lumbar skin infection
  • Raised intracranial pressure.  (A fundoscopy must be performed before the procedure)
  • Supratentorial mass lesions
  • Sever bleeding diathesis
  • Platelet count less than 50,000/cu mm.

PRE- and POST-PROCEDURE PATIENT EDUCATION:

Procedure is performed under local anesthesia, therefore patient can eat or drink any time before or after the procedure.  The patient is usually asked to remain flat in the bed (on the back) for about 4 hours post-procedure to prevent post-lumbar puncture headaches.  Ask the patient to notify the physician of any persistent headaches, pain, drainage, fever or spreading redness around the puncture site.

Questions & Answers
Q.  Why is lumbar puncture performed?
A.   It is not normal to have infectious agents (i.e., bacteria, viruses, blood, abnormal cells or abnormal amounts of protein) in the cerebrospinal fluid.  Evaluation of the fluid may help your physician determine the cause of the abnormality.
Q.  Does it hurt?
A.  Yes, but most people say it is not much worse than having your blood drawn.  
Q.  What sort of things can go wrong?
A.  The most common problem that may occur is a post lumbar puncture headache, which is usually self limiting and occurs 24 to 48 hours after the procedure.  The pain is reduced if the patient remains at bed rest for at least 4 to 6 hours following the procedure.

Other problems that can occur are local pain in the back at the site of the needle introduction and shooting pains in the lower extremities that are usually transient. 

Q.  What can I do to make things go smoothly?
A.  The most important thing for you to do is to remain still in a "fetal position".  Bend your knees and thighs and flex your head and trunk as much as you can, so that you are in a "fetal position".  This position will open up the space between the vertebrae for easy introduction of the spinal needle into the cerebrospinal space (watch the video for correct positioning).  Once the procedure is finished, lay on your back for at least four hours.  Inform the physician if you have headache, fever, chills, or redness at puncture site.  
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Procedures Presented By Physicians Certified By
The American Board of Internal Medicine and Medical Subspecialties

 

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