Lumbar puncture

Question 1

Why do you perform LP in GBS?

Answer 1

Albuminocytologic dissociation—an increase in protein with normal white blood cell count—is noted in nine out of 10 patients within one week of symptom onset. An increased lymphocyte count would be inconsistent with GBS and may suggest sarcoidosis, Lyme disease neuropathy, or recent HIV infection

Question 2

What are the indications for performing LP?

Answer 2

Diagnostic/investigative: MS, SAH, meningitis, GBS
Therapy

Question 3

Name two indications in which LP can be therapeutic

Answer 3

normal pressure hydrocephalus
idiopathic intracranial hypertension (IIH)

Question 4

What are the features of normal pressure hydrocephalus

Answer 4

parkinsonian gait
dementia
urinary incontinence

Question 5

wet, wacky, wobbly, describes which condition

Answer 5

normal pressure hydrocephalus= reversible cause of dementia

Question 6

Two risk factors for idiopathic intracranial HTN?

Answer 6

female, obese

Question 7

What is the management of IIH?

Answer 7

lose weight, acetazolamide (carbonic anyhdrase inhibitor)

Question 8

When must patient be lying down to perform LP?

Answer 8

if you need to measure opening pressure!! E.g. to assess for IIH. If they are sitting then gravity interferes with pressure

Question 9

What are two common complications of LP?

Answer 9

headache and infection/bleeding

Question 10

What are two rarer complications of LP?

Answer 10

chronic back pain and nerve damage