Introduction to Clinical Skills: Lumbar Puncture

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Introduction to Clinical Skills Lumbar Puncture
Gregory Gruener, M.D. Department of Neurology
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Considerations

• Why is an LP Being Done?
• Is this the Only Test Available?
• What Positive Information is Expected?
• Is the Patient Stable?

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Indications

• Diagnostic
• Infection
• Subarachnoid Hemorrhage
• Multiple Sclerosis
• Therapeutic
• Neoplasm
• Incidental
• Myelography

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Contraindications

• Suspected Increase in ICP
• Suspected Spinal Cord Compression
• Infection at the Site of an LP
• Coagulopathy

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Normal CSF Values

• Appears to be clear and colorless
• Opening Pressure 120 mm/H20
• Protein level 35 mg
• Glucose level 60 mg
• (60 of serum glucose)
• Cells lt 5 lymphocytic/monocytic

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CSF Profiles
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Proper Positioning (one)
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Proper Positioning (two)
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Preparation for the LP (one)
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Preparation for the LP (two)
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Injection of the skin
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Proper Positioning (one)
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Proper Positioning (two)
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Incorrect Position (one)
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Incorrect Position (two)
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Alternative Techniques

• Sitting Position
• Radiological Guidance
• Cisternal Tap
• Cervical Tap
• Lumbar Puncture Technique in Neonates and Infants

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Complications

• Headache (Post LP Headache)
• Painful Paresthesias
• Persistent Pain or Paresthesias
• Spinal Hematoma
• Spinal Infection
• Herniation

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CSF Leak (one)
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CSF Leak (two)
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Complications

• Headache
• Painful Paresthesias
• Persistent Pain or Paresthesias
• Spinal Hematoma
• Spinal Infection
• Herniation

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Complications

• Headache
• Painful Paresthesias
• Persistent Pain or Paresthesias
• Spinal Hematoma or a Bloody Tap
• Spinal Infection
• Herniation

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Bloody Tap
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Complications

• Headache
• Painful Paresthesias
• Persistent Pain or Paresthesias
• Spinal Hematoma
• Spinal Infection
• Herniation

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Complications

• Headache
• Painful Paresthesias
• Persistent Pain or Paresthesias
• Spinal Hematoma
• Spinal Infection
• Herniation (Brain not the disc)

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