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Encyclopedia > Lumbar puncture
A patient undergoes a lumbar puncture at the hands of a neurologist. The reddish-brown swirls on the patient's back are iodine (a disinfectant).
A patient undergoes a lumbar puncture at the hands of a neurologist. The reddish-brown swirls on the patient's back are iodine (a disinfectant).

In medicine, a lumbar puncture (colloquially known as a spinal tap) is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or—rarely—to relieve increased intracranial pressure. Image File history File linksMetadata Download high resolution version (2272x1704, 1450 KB) Summary this is my picture of me getting a spinal tap. ... Image File history File linksMetadata Download high resolution version (2272x1704, 1450 KB) Summary this is my picture of me getting a spinal tap. ... General Name, Symbol, Number iodine, I, 53 Chemical series halogens Group, Period, Block 17, 5, p Appearance violet-dark gray, lustrous Standard atomic weight 126. ... This is an article about antimicrobial agents. ... medicines, see Medication. ... Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... Biochemistry is the study of the chemical processes and transformations in living organisms. ... This article does not cite any references or sources. ... Cytology (also known as Cell biology) is the scientific study of cells. ...

Contents

Indications

The most common purpose for a lumbar puncture is to collect cerebrospinal fluid in a case of suspected meningitis, since there is no other reliable tool with which meningitis can be excluded and it is often a life-threatening but highly treatable condition. Young infants commonly require lumbar puncture as a part of the routine workup for fever without a source, as they have a much higher risk of meningitis than older persons and do not reliably show signs of meningeal irritation (meningismus). For instance, most experts agree that any infant less than 2 months of age with fever of 38 degrees Celsius (100.4 degrees Fahrenheit) or greater and no identifiable source requires a lumbar puncture.[citation needed] In any age group, subarachnoid hemorrhage, hydrocephalus, benign intracranial hypertension and many other diagnoses may be supported or excluded with this test. Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ... A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... This article is actively undergoing a major edit. ...


Lumbar punctures may also be done to inject medications into the cerebrospinal fluid, particularly for spinal anesthesia or chemotherapy. Spinal anaesthesia is a form of local, or more specifically regional, anaesthesia involving injection of a local anaesthetic into the cerebrospinal fluid (CSF), generally through a long fine needle. ... Chemotherapy is the use of chemical substances to treat disease. ...


Procedure

A lumbar puncture requires aseptic technique (sterile) and performance by qualified and skilled medical practitioners. Aseptic technique refers to a procedure that is performed under sterile conditions. ...


In performing a lumbar puncture, first the patient is usually placed in a left (or right) lateral position with his/her neck bent in full flexion and knees bent in full flexion up to his/her chest, approximating a fetal position as much as possible. It is also possible to have the patient sit on a stool and bend his/her head and shoulders forward. The area around the lower back is prepared using aseptic technique. Once the appropriate location is palpated, local anaesthetic is infiltrated under the skin and then injected along the intended path of the spinal needle. A spinal needle is inserted between the lumbar vertebrae L3/L4 or L4/L5 and pushed in until there is a "give" that indicates the needle is past the dura mater. The stylet from the spinal needle is then withdrawn and drops of cerebrospinal fluid are collected. The opening pressure of the cerebrospinal fluid may be taken during this collection by using a simple column manometer. The procedure is ended by withdrawing the needle while placing pressure on the puncture site. In the past, the patient would often be asked to lie on his/her back for at least six hours and be monitored for signs of neurological problems, though there is no scientific evidence that this provides any benefit. The technique described is almost identical to that used in spinal anesthesia, except that spinal anesthesia is more often done with the patient in a sitting position. In sciences dealing with the anatomy of animals, precise anatomical terms of location are necessary for a variety of reasons. ... In anatomy, Flexion is movement whereby bones or other objects are brought closer together. ... Fetal position(also spelt FOETAL) is a medical term used to describe the positioning of the body of a prenatal fetus as it develops. ... A diagram of a thoracic vertebra. ... The dura mater (from the Latin hard mother), or pachymeninx, is the tough and inflexible outermost of the three layers of the meninges surrounding the brain. ... A manometer is a pressure measuring instrument, often also called pressure gauge. ... Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. ...


The seated position is advantageous in that there is less distortion of spinal anatomy which allows for easier withdrawal of fluid. It is preferred by some practitioners when a lumbar puncture is performed on an obese patient where having them lie on their side would cause a scoliosis and unreliable anatomical landmarks. On the other hand, opening pressures are notoriously unreliable when measured on a seated patient and therefore the left or right lateral (laying down) position is preferred if an opening pressure needs to be measured.


Patient anxiety during the procedure can lead to increased CSF pressure, especially if the person holds their breath, tenses their muscles or flexes their knees too tightly against their chest. Diagnostic analysis of changes in fluid pressure during lumbar puncture procedures requires attention both to the patient's condition during the procedure and to their medical history.[citation needed] Fluid pressure is the pressure on an object submerged in a fluid, such as water. ... The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ...


Risks

The risks and benefits of a lumbar puncture should be discussed in detail with the patient by the practitioner who will be performing the procedure. Almost always, when it is indicated, the benefits significantly outweigh the risks.[citation needed]


Headache with nausea is the most common complication; it often responds to analgesics and infusion of fluids and can often be prevented by strict maintenance of a supine posture for two hours after the successful puncture. Merritt's Neurology (10th edition), in the section on lumbar puncture, notes that intravenous caffeine injection is often quite effective in aborting these so-called "spinal headaches." Contact between the side of the LP needle and a spinal nerve root can result in anomalous sensations (paresthesia) in a leg during the procedure; this is harmless and patients can be warned about it in advance to minimize their anxiety if it should occur. A headache that is persistent despite a long period of bedrest and occurs only when sitting up may be indicative of a CSF leak from the lumbar puncture site. It can be treated by more bedrest, or by a "blood patch", performed by a neurosurgeon injecting the patient's own blood back into the site of leakage under radiologic guidance to cause a clot to form and seal off the leak. A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep. // Transient paresthesia is the temporary sensation of tingling...


Serious complications of a properly performed lumbar puncture are extremely rare. They include spinal or epidural bleeding, and trauma to the spinal cord or spinal nerve roots resulting in weakness or loss of sensation, or even paraplegia. The latter is exceedingly rare, since the level at which the spinal cord ends (normally the inferior border of L1, although it is slightly lower in infants) is several vertebral spaces above the proper location for a lumbar puncture (L3/L4 or L4/L5). There are case reports of lumbar puncture resulting in perforation of abnormal dural arterio-venous malformations, resulting in catastrophic epidural hemorrhage; this is exceedingly rare. The Spinal cord nested in the vertebral column. ... The term spinal nerve generally refers to the mixed spinal nerve, which is formed from the dorsal and ventral roots that come out of the spinal cord. ... Paraplegia is a condition in which the lower part of a persons body is paralyzed and cannot willfully function. ... Arteriovenous malformation or AVM is a congenital disorder of the veins and arteries that make up the vascular system . ...


The procedure is not recommended when epidural infection is present or suspected, when topical infections or dermatological conditions pose a risk of infection at the puncture site or in patients with severe psychosis or neurosis with back pain. Some authorities believe that withdrawal of fluid when initial pressures are abnormal could result in spinal cord compression or cerebral herniation; others believe that such events are merely coincidental in time, occurring independently as a result of the same pathology that the lumbar puncture was performed to diagnose. In any case, computerized tomography of the brain is often performed prior to lumbar puncture if an intracranial mass is suspected. An epidural catheter after insertion. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Herniation, a deadly side effect of very high intracranial pressure, occurs when the brain shifts across structures within the skull. ...


Removal of cerebrospinal fluid resulting in reduced fluid pressure has been shown to correlate with greater reduction of cerebral blood flow among patients with Alzheimer's disease. Its clinical significance is uncertain.


Diagnostics

Increased CSF pressure can indicate congestive heart failure, cerebral edema, subarachnoid hemorrhage, hypo-osmolality resulting from hemodialysis, meningeal inflammation, purulent meningitis or tuberculous meningitis, hydrocephalus, or pseudotumor cerebri. Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... Cerebral edema is swelling of the brain which can occur as the result of a head injury, cardiac arrest or from the lack of proper altitude acclimatization. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... Benign intracranial hypertension (BIH), also known by the obsolete term pseudotumor cerebri is a neurologic disease that is caused by increased intracranial pressure in the subarachnoid space surrounding the brain without any indication of intracranial pathology. ...


Decreased CSF pressure can indicate complete subarachnoid blockage, leakage of spinal fluid, severe dehydration, hyperosmolality, or circulatory collapse. Significant changes in pressure during the procedure can indicate tumors or spinal blockage resulting in a large pool of CSF, or hydrocephalus associated with large volumes of CSF. Lumbar puncture for the purpose of reducing pressure is performed in some patients with idiopathic intracranial hypertension (also called pseudotumor cerebri.) Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ...


The presence of white blood cells in cerebrospinal fluid is called pleocytosis. A small number of monocytes can be normal; the presence of granulocytes is always an abnormal finding. A large number of granulocytes often heralds bacterial meningitis. White cells can also indicate reaction to repeated lumbar punctures, reactions to prior injections of medicines or dyes, central nervous system hemorrhage, leukemia, recent epileptic seizure, or a metastatic tumor. When peripheral blood contaminates the withdrawn CSF, a common procedural complication, white blood cells will be present along with erythrocytes, and their ratio will be the same as that in the peripheral blood. A scanning electron microscope image of normal circulating human blood. ... Pleocytosis is a term used to describe a condition of increased white blood cell count in a bodily fluid, such as cerebrospinal fluid (CSF), indicative of an inflammatory, infectious, or malignant condition. ... Monocyte A monocyte is a leukocyte, part of the human bodys immune system that protect against blood-borne pathogens and move quickly to sites of infection in the tissues. ... Eosinophil granulocyte Basophil granulocyte Granulocytes are a category of white blood cells characterised by the presence of granules in their cytoplasm. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Leukemia or leukaemia (see spelling differences) is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes). ... This article is about the medical term, epileptic seizure, as distinct from a non-epileptic seizure. ... Tumor or tumour literally means swelling, and is sometimes still used with that meaning. ... A scanning electron microscope image of normal circulating human blood. ... Human red blood cells Red blood cells are the most common type of blood cell and are the vertebrate bodys principal means of delivering oxygen to body tissues via the blood. ...


Several substances found in cerebrospinal fluid are available for diagnostic measurement.

  • Measurement of chloride levels may aid in detecting the presence of tuberculous meningitis.
  • Glucose is usually present in the CSF; the level is usually about 60% that in the peripheral circulation. A fingerstick or venipuncture at the time of lumbar puncture may therefore be performed to assess peripheral glucose levels in order to determine a predicted CSF glucose value. Decreased glucose levels can indicate fungal, tuburculous or pyogenic infections; lymphomas; leukemia spreading to the meninges; meningoencephalitic mumps; or hypoglycemia. A glucose level of less than one third of blood glucose levels in association with low CSF lactate levels is typical in hereditary CSF glucose transporter deficiency.
  • Increased glucose levels in the fluid can indicate diabetes, although the 60% rule still applies.
  • Increased levels of glutamine are often involved with hepatic encephalopathies, Reye's syndrome, hepatic coma, cirrhosis and hypercapnia.
  • Increased levels of lactate can occur the presence of cancer of the CNS, multiple sclerosis, heritable mitochondrial disease, low blood pressure, low serum phosphorus, respiratory alkalosis, idiopathic seizures, traumatic brain injury, cerebral ischemia, brain abscess, hydrocephalus, hypocapnia or bacterial meningitis.
  • The enzyme lactate dehydrogenase can be measured to help distinguish meningitides of bacterial origin, which are often associated with high levels of the enzyme, from those of viral origin in which the enzyme is low or absent.
  • Changes in total protein content of cerebrospinal fluid can result from pathologically increased permeability of the blood-cerebrospinal fluid barrier, obstructions of CSF circulation, meningitis, syphilis, brain abscesses, subarachnoid hemorrhage, polio, collagen disease or Guillain-Barré syndrome, leakage of CSF, increases in intracranial pressure or hyperthyroidism. Very high levels of protein may indicate tuberculous meningitis or spinal block.
  • IgG synthetic rate is calculated from measured IgG and total protein levels; it is elevated in immune disorders such as multiple sclerosis, transverse myelitis, and neuromyelitis optica of Devic.
  • Numerous antibody-mediated tests for CSF are available in some countries: these include rapid tests for antigens of common bacterial pathogens, treponemal titers for the diagnosis of neurosyphilis and Lyme disease, Coccidiodes antibody, and others.
  • The India ink test is still the standard for detection of meningitis caused by Cryptococcus neoformans.
  • CSF can be sent to the microbiology lab for various types of smears and cultures to diagnose infections.
  • Polymerase chain reaction (PCR) has been a great advance in the diagnosis of some types of meningitis. It has high sensitivity and specificity for many infections of the CNS, is fast, and can be done with small volumes of CSF. Even though testing is expensive, it saves cost of hospitalization.

The chloride ion is formed when the element chlorine picks up one electron to form an anion (negatively-charged ion) Cl−. The salts of hydrochloric acid HCl contain chloride ions and can also be called chlorides. ... Tuberculous meningitis is also called TB meningitis. Tuberculous meningitis is Mycobacterium tuberculosis infection of the meninges. ... Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ... Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Glutamine is one of the 20 amino acids encoded by the standard genetic code. ... Reyes syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver. ... Cirrhosis of the liver is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. ... Lactic acid is a chemical compound that plays a role in several biochemical processes. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... A diagram showing the CNS: 1. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... General Name, Symbol, Number phosphorus, P, 15 Chemical series nonmetals Group, Period, Block 15, 3, p Appearance waxy white/ red/ black/ colorless Standard atomic weight 30. ... Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. ... Lactate dehydrogenase (LDH) is an enzyme (EC 1. ... The blood-brain barrier is a physical barrier between the blood vessels in the central nervous system, and most parts of the central nervous system itself. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Syphilis is a sexually transmitted disease caused by Treponema pallidum. ... Look up Abscess in Wiktionary, the free dictionary. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Poliomyelitis (polio), or infantile paralysis, is a viral paralytic disease. ... Guillain-Barré syndrome (GBS) or acute inflammatory demyelinating polyradiculoneuropathy is an acute, autoimmune disease that affects the peripheral nervous system and is usually triggered by an acute infectious process. ... Hyperthyroidism (or overactive thyroid gland) is the clinical syndrome caused by an excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both. ... Syphilis is a sexually transmitted disease caused by Treponema pallidum. ... Lyme disease (Borreliosis) is a bacterial infection with a spirochete from the species complex Borrelia burgdorferi, which is most often acquired from the bite of an infected Ixodes, or black-legged, tick, also known as a deer tick. ... Cryptococcus neoformans is an encapsulated yeastlike fungus that can live in both plants and animals. ... This article does not cite any references or sources. ... PCR tubes in a stand after a colony PCR The polymerase chain reaction (PCR) is a biochemistry and molecular biology technique[1] for exponentially amplifying DNA, via enzymatic replication, without using a living organism (such as E. coli or yeast). ...

External links

  • eMedicine: Lumbar puncture
  • Medstudents: Procedures: Lumbar puncture

References


  Results from FactBites:
 
eMedicine - Lumbar Puncture (CSF Examination) : Article by Roy Sucholeiki, MD (2624 words)
LP is performed in the interspaces between the lumbar vertebrae, usually at the L4-L5 level.
Adler MD, Comi AE, Walker AR: Acute hemorrhagic complication of diagnostic lumbar puncture.
Hyland K: The lumbar puncture for diagnosis of pediatric neurotransmitter diseases.
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Lumbar puncture within the past Monitor closely for the james gordon and chiropractic development of adverse reactions to therapy and remedy.
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Read more is made by the clinical features characteristic changes in the spinal fluid from a lumbar puncture A newer remedy chiropractic college washington d c involves the intravenous injection of gamma globulin which is thought to block pain as a symptom of pneumonia natural remedy and migraine or tension los angeles chiropractic college headache.
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