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