Lumber puncture

Adult & serology.

 Defination:
• Lumber puncture (or LP, and colloquially
known as a spinal tap) is a diagnostic and at
times therapeutic procedure that is performed
in order 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
intracranial pressure.
 indication
 to collect cerebrospinal fluid in a case of
suspected meningitis
 Young infants commonly require lumbar
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
 to inject medications into the cerebrospinal
fluid ("intrathecally"), particularly for
spinal anesthesia or chemotherapy
 to detect the presence of malignant cells in
the CSF, as in carcinomatous meningitis or
medulloblastoma.
 Contraindications
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 stat
– Recent history of seizure
– Focal neurological signs
• Bleeding diathesis
Coagulopathy