which is the movement of brain tissue from its normal position in your skull. Complications of lumbar puncture followed by anticoagulation. Learn about the lumbar puncture procedure (spinal tap procedure) and its risks. Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion. Vavricka, S.R., Walter, R.B., Irani, S., Halter, J. Lumbar puncture and brain herniation in acute bacterial meningitis: a review. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Practice Guidelines for the Management of Bacterial Meningitis. DOes this adult patient have acute meningitis? JAMA 282, 175-181 (1999).Ģ. Infection at the site of needle insertionġ. Consider how patient positioning could jeopardize the patients breathing or volume status.Delay non-urgent LP’s 12-24 hours after prophylactic anticoagulation.Therapeutic anticoagulation should be avoided.Therapeutic anticoagulation increases the incidence of spinal hematoma and paraparesis to an absolute risk of 2%.Plavix and other anti-platelet medications have not been studied.No risk of bleeding has been seen with aspirin.Hyper-dense subdural hematoma causing midline shift and compression of the lateral ventricle. Ask yourself: are there any black fluid filled spaces in the brain that are missing on this CT?.Meningococcal CSF cultures are often (-) 1 hour after antibiotics, but strep pneumonia CSF will remain (+) 4 hours after antibiotics 3.Blood cultures -> Antibiotics + Dexamethasone -> CT -> LP.If suspecting bacterial meningitis but need a CT, work up the patient in this order.IDSA recommends head CT prior to LP if 2.This makes it easier for the doctor to insert the needle. Wide variety of indications including suspicion for multiple sclerosis, guillain barre, paraneoplastic antibodies, leptomeningeal carcinomatosis, normal pressure hydrocephalus, pseudotumor cerebriĬontraindications Increased Intracranial Pressure preferred for accurate opening pressure measurement, so the spaces between the vertebrae are as wide as possible. The purpose of this study was to identify the patient position for lumbar puncture associated with the widest interspinous distance utilizing ultrasound.For a thunderclap headache and a negative head CT, an LP should be performed to look for xanthochromia.If any one of these three are present you cannot rule out meningitis.Absence of fever, headache, AND altered mental status.If this does not worsen their headache, then you can rule out meningitis. Patient turns their head horizontally 2 rotations a second for several seconds.Only 2 effective ways to rule out meningitis.

Fever, neck stiffness, altered mental status, and headache are the most common symptoms. It is very difficult to clinically rule out meningitis with out an LP.

Lumbar puncture position