Post on 05-Jan-2016
description
Introduction to Clinical Skills:Introduction to Clinical Skills: Lumbar PunctureLumbar Puncture
Gregory Gruener, M.D.
Department of Neurology
ConsiderationsConsiderations
• Why is an LP Being Done?• Is this the Only Test Available?• What Positive Information is
Expected?• Is the Patient Stable?
IndicationsIndications• Diagnostic
• Infection• Subarachnoid Hemorrhage• Multiple Sclerosis
• Therapeutic• Neoplasm
• Incidental• Myelography
ContraindicationsContraindications
• Suspected Increase in ICP• Suspected Spinal Cord
Compression• Infection at the Site of an LP• Coagulopathy
Normal CSF ValuesNormal 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’sCSF Profile’s
Pressure Cells Protein Glucose
Bacterial Meningitis
(PMN’s)
to
Viral Meningitis
N to
to (Mono’s)
N
Proper PositioningProper Positioning (one)(one)
Proper PositioningProper Positioning (two)(two)
Preparation for the LPPreparation for the LP (one)(one)
Preparation for the LPPreparation for the LP (two)(two)
Injection of the skinInjection of the skin
Proper PositioningProper Positioning (one)(one)
Proper PositioningProper Positioning (two)(two)
Incorrect PositionIncorrect Position (one)(one)
Incorrect PositionIncorrect Position (two)(two)
Alternative TechniquesAlternative Techniques
• Sitting Position• Radiological Guidance• Cisternal Tap• Cervical Tap• Lumbar Puncture Technique in
Neonates and Infants
ComplicationsComplications
• Headache (Post LP Headache)• Painful Paresthesias• Persistent Pain or Paresthesias• Spinal Hematoma• Spinal Infection• Herniation
CSF LeakCSF Leak (one)(one)
CSF LeakCSF Leak (two)(two)
ComplicationsComplications
• Headache• Painful Paresthesias• Persistent Pain or Paresthesias• Spinal Hematoma• Spinal Infection• Herniation
ComplicationsComplications
• Headache• Painful Paresthesias• Persistent Pain or Paresthesias• Spinal Hematoma or a Bloody Tap• Spinal Infection• Herniation
““Bloody Tap”Bloody Tap”
ComplicationsComplications
• Headache• Painful Paresthesias• Persistent Pain or Paresthesias• Spinal Hematoma• Spinal Infection• Herniation
ComplicationsComplications
• Headache• Painful Paresthesias• Persistent Pain or Paresthesias• Spinal Hematoma• Spinal Infection• Herniation (Brain not the disc)