A patient undergoes a lumbar puncture at thehands of a neurologist. The reddish-brown swirlson the patient's back are tincture of iodine (anantiseptic).
In medicine, a
(colloquially known as a
)is a diagnostic and at times therapeutic procedure that is performed inorder to collect a sample of cerebrospinal fluid (CSF) for biochemical,microbiological, and cytological analysis, or very rarely as a treatment("therapeutic lumbar puncture") to relieve increased intracranialpressure.
The most common purpose for a lumbar puncture is to collectcerebrospinal fluid in a case of suspected meningitis, since there is noother reliable tool with which meningitis, a life-threatening but highlytreatable condition, can be excluded. Young infants commonly requirelumbar puncture as a part of the routine workup for fever without a source, as they have a much higher risk of meningitis than older persons and do not reliably show signs of meningeal irritation (meningismus). In any agegroup, subarachnoid hemorrhage, hydrocephalus, benign intracranial hypertension and many other diagnoses may besupported or excluded with this test.Lumbar punctures may also be done to inject medications into the cerebrospinal fluid ("intrathecally"), particularlyfor spinal anesthesia or chemotherapy. It may also be used to detect the presence of malignant cells in the CSF, as incarcinomatous meningitis or medulloblastoma.
Lumbar puncture should not be performed in the following situations•Idiopathic (unidentified cause) increased intracranial pressure (ICP)•Rationale: lumbar puncture in the presence of increased ICP may cause uncal herniation•Exception: therapeutic use of lumbar puncture to reduce ICP•Precaution•CT brain is advocated by some, especially in the following situations•Age >65•Reduced GCS or conscious state•Recent history of seizure•Focal neurological signs•Ophthalmoscopy for papilledema•Bleeding diathesis•Coagulopathy•Decreased platelet count (<50 x 10
•Skin infection at puncture site•Sepsis•Abnormal respiratory pattern•Hypertension with bradycardia and deteriorating consciousness•Vertebral deformities (scoliosis or kyphosis), in hands of an unexperienced physician or physician assistant.