Fluoroscopy-guided lumbar puncture (LP) is a minimally invasive, image-guided diagnostic and therapeutic procedure that involves the removal of a small volume of cerebrospinal fluid (CSF) from, or an injection of medication or other substance (e.g. The latter is usually inferred from the following characteristic findings on computed tomography (CT) of the brain:Suspicion of subarachnoid hemorrhage (SAH)Increased intracranial pressure (ICP)The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.Loss of the quadrigeminal plate cisternPatients with an abnormal level of consciousnessPatients with known CNS lesionsThe lumbar spine consists of 5 moveable vertebrae numbered L1-L5.The lumbar vertebrae have a vertical height that is less than their horizontal diameter. Lumbar puncture, also known as spinal tap, is an invasive procedure where a hollow needle is inserted into the space surrounding the subarachnoid space in the lower back to obtain samples of cerebrospinal fluid (CSF) for qualitative analysis. The size of the vertebral body increases from L1 to L5, indicative of the increasing loads that each lower lumbar vertebra absorbs. Most cases were due to normal skin flora such as Cutibacterium species and coagulase negative staphylococci [44-46]. More than 90% of cases of acute bacterial meningitis present with a CSF white cell count of more than 100 cells per μL. A lumbar puncture (spinal tap) is performed in your lower back, in the lumbar region. It is preferable to obtain a CSF specimen prior to antibiotic administration, however this should not be unduly delayed in a child with signs of meningitis or sepsis.The most important determinant of a successful lumbar puncture is a strong, calm, experienced assistant to hold the patient.
During a lumbar puncture, a needle is inserted between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid. Lumbar puncture is indicated for both diagnostic and therapeutic reasons. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Fever, neck stiffness, altered mental status, and headache are the most common symptoms. Lumbar puncture (LP) can confirm or exclude meningitis. Kathleen Brown MD, Deena Berkowitz MD, MPH, in Pediatric Emergency Medicine, 2008. Knowledge of the contraindications, the pertinent anatomy, and the methods to minimize the risk of … It is essential to position the patient correctly and take your time.
Ab… CSF will drip out of the needle if it’s properly positioned. Lumbar puncture, also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid for diagnostic testing. A guide to indications / contraindications / procedural technique related to performing a lumbar puncture Lumbar puncture is a potentially uncomfortable procedure that must not be rushed. Contraindications to lumbar puncture as defined by computed cranial tomography. CSF analysis may aid in the diagnosis of meningitis, multiple sclerosis, intracranial hemorrhage, or meningeal carcinomatosis. These complications presumably result from direct inoculation of bacteria into the vertebral bone. Of note, the L5 vertebra has the heaviest body, smallest spinous process, and thickest transverse process.Patients who are immunocompromisedDisclosure: Nothing to disclose.Patients with papilledema seen on physical examination, with clinical suspicion of an elevated ICPExplain the procedure, benefits, risks, complications, and alternative options to the patient or the patient’s representative, and obtain a signed informed consentNever allow a lumbar puncture or a pre–lumbar puncture CT scan to delay administration of intravenous (IV) antibiotics; meningitis can usually be inferred from the cell count, antigen detection, or bothPatients with focal findings on neurologic examinationPatients who are older than 60 yearsLumbar puncture should be performed for the following indications:Loss of the superior cerebellar cisternPatients who have had a seizure within 1 week of presentationDisclosure: Nothing to disclose.Absolute contraindications for lumbar puncture are the presence of infected skin over the needle entry site and the presence of unequal pressures between the supratentorial and infratentorial compartments.
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