Introduction to Clinical Skills: Lumbar Puncture

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Presentation transcript:

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

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

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

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

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 < 5 lymphocytic/monocytic

CSF Profile’s

Proper Positioning (one)

Proper Positioning (two)

Preparation for the LP (one)

Preparation for the LP (two)

Injection of the skin

Proper Positioning (one)

Proper Positioning (two)

Incorrect Position (one)

Incorrect Position (two)

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

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

CSF Leak (one)

CSF Leak (two)

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

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

“Bloody Tap”

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

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