User Tools

Site Tools


lumbar_puncture

Lumbar puncture

A lumbar puncture (or LP, and colloquially known as a spinal tap) is a diagnostic and at times therapeutic medical procedure.

Indications

Diagnostically it is used to collect cerebrospinal fluid (CSF) to confirm or exclude conditions such as meningitis and subarachnoid hemorrhage and it may be used in diagnosis of other conditions.

Therapeutically it may be used to reduce increased intracranial pressure.

see Lumbar puncture for subarachnoid hemorrhage.

Heinrich Quincke in 1897 reported the first cases of idiopathic intracranial hypertension (IIH) shortly after he introduced the lumbar puncture into medicine.

Technique

The procedure is typically performed under local anesthesia and aseptic technique. A needle is used to access the subarachnoid space and fluid collected. Fluid may be sent for biochemical, microbiological, and cytological analysis.

Lumbar puncture was first introduced in 1891 by the German physician Heinrich Quincke.

Complications

Lumbar puncture is a safe and commonly performed procedure, with an overall complication rate of 0.1% to 0.5%.

Under some circumstances, lumbar puncture cannot be performed safely (e.g. a severe bleeding tendency). It is regarded as a safe procedure, but post-dural-puncture headache is common.

Lapadula et al. report a case of a young man with epilepsy who, after a lumbar puncture performed for research purposes, presented with an intracerebral hematoma and neurological deficits. To the best of our knowledge, post-tap intraparenchymal hematoma is extremely rare and only 1 case has been reported previously. In consideration, all patients undergoing a lumbar puncture should be informed about this possible rare complication, even in the absence of documented hemorrhagic risk factors 1).


The Department of Neurosurgery, Hospital Network Antwerp, Belgium published a case of severe bilateral subdural hematomas as a complication of diagnostic lumbar puncture for possible Alzheimer's disease 2).

Contraindications

Well-known contraindications to lumbar puncture are an intracranial tumor, obstructive hydrocephalus, coagulopathy, and ruptured aneurysm with subarachnoid hemorrhage.

1)
Lapadula G, Caporlingua F, Caporlingua A, Currà A, Fattapposta F, Missori P. Delayed Intraparenchymal Hematoma Following Diagnostic Lumbar Puncture. Neurologist. 2015 Oct;20(4):70-3. doi: 10.1097/NRL.0000000000000055. PubMed PMID: 26468872.
2)
Verslegers L, Schotsmans K, Montagna M, Feyen B, De Jong L, Crols R, Engelborghs S. Severe bilateral subdural hematomas as a complication of diagnostic lumbar puncture for possible Alzheimer's disease. Clin Neurol Neurosurg. 2016 Dec 8;152:95-96. doi: 10.1016/j.clineuro.2016.12.003. [Epub ahead of print] PubMed PMID: 27978461.
lumbar_puncture.txt · Last modified: 2016/12/20 16:25 (external edit)