Physicians may have to treat suspected meningitis being deprived of cerebrospinal fluid (CSF) analysis guidance, since getting parental consent for lumbar puncture may be problematic.ĭuring lumbar puncture, airway and resuscitation equipment should be immediately at hand. Lumbar puncture can be performed safely in patients with thrombocytopenia less than 10,000/μL, if they receive transfusion to a peripheral platelet count greater than 50,000/μL, and in patients with coagulopathy after appropriate correction of factor deficiency. Lumbar puncture should always be performed as soon as the infant becomes clinically stable and can tolerate the procedure even if it has not been possible to be performed at the first suspicion of meningitis. It seems that Heinrich Irenäus Quincke was the first person in medical history to use lumbar puncture for therapeutic, and subsequently, diagnostic purposes.Įmpirical antibiotic therapy for suspected meningitis, which should ideally succeed lumbar puncture, should be started immediately if lumbar puncture is to be delayed. When LP is traumatic, the wisest approach is to assume the patient is having meningitis and start empirical therapy. Infection, spinal hematoma, epidermoid tumor, and cerebral herniation are the main complications of LP. Ultrasound may minimize the number of LP attempts and decrease patient and parent anxiety by easily identifying an insertion site. Lack of local anesthetic use and advancement of the spinal needle with the stylet in place were most prominent risk factors for a traumatic LP. Altered mental status, focal neurologic signs, papilledema, focal seizure, and risk for brain abscess are indications for cranial imaging before performing LP. Contraindications of lumbar puncture include findings of increased intracranial pressure, bleeding diathesis, cardiopulmonary instability, soft tissue infection at the puncture site, shock, respiratory insufficiency, and suspected meningococcal septicemia with extensive or spreading purpura.
Indications of lumbar puncture include suspected meningitis, suspected subarachnoid hemorrhage, administration of chemotherapeutic agents, instillation of contrast media for imaging of the spinal cord, and the evaluation of various neurologic conditions including normal pressure hydrocephalus and Guillain-Barré syndrome, and the treatment of idiopathic intracranial hypertension. Heinrich Irenäus Quincke was the first person in medical history to perform lumbar puncture (LP).
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