Lumbar Puncture (140-155)

Question 1

Name three indications for performing lumbar puncture?;

Answer 1

1. Subarchnoid haemorrhage. 2. Menigitis. 3. Pyrexia of unknown origin.

Question 2

Name four contraindications for performing a lumbar puncture;

Answer 2

Systemtic- coagulpathic (INR raised), low platelets, anaemia. Local- sciolosis, infection/abscess, structural deformity

Question 3

What layers would you go through when performing a lumbar puncture;

Answer 3

Skin, subcataneous fat, thoracolumlar fascia, supraspinous ligament, intraspinous ligament, ligament flavum, epidural space, dura mater, subdural space, archnoid mater, subarachnoid space.

Question 4

Name four complications following a lumbar puncture;

Answer 4

CSF leak, epidural abscess, headache, venous bleed

Question 5

How can some of the complications following a lumbar puncture be minimised or prevented?;

Answer 5

Pt optimised with adequate fluids (not hypotensive). The bevel of the needle is parallel to orintation of muscle fibres. Only take 5-10ml CSF. Apply pressure if CSF leak.

Question 6

What structures pass through the intervertebral foramen?;

Answer 6

1. Root of each spinal nerve.
2. Spinal artery.
3. Communicating spinal veins.
4. Transforaminal ligament.

Question 7

What are the contents of the epidural space?;

Answer 7

Fat, lymphatics, spinal nerves with their dural sleeves, dural venous plexuses (Baston’s plexus), small arteries

Question 8

What is the origin of the sympathetic nervous system?;

Answer 8

Thorocolumbar- T1-12, L1-2. (T1-L2)

Question 9

What is the origin of the parasympathetic nervous system?;

Answer 9

Craniosacral- CN III, VII, IX & X and S2-S4

Question 10

What is the nerve supply to the heart;

Answer 10

Sympathetic- T1-T4. Parasympathetic- Vagus (CN X)

Question 11

What is the nerve supply to the foregut?;

Answer 11

Sympathetic- Greater splanchic (T5-T9). Parasympathetic- Vagus (CN X)

Question 12

What is the nerve supply to the midgut?;

Answer 12

Sympathetic- Lesser splanchnic (T10-T12). Parasympathetic- Vagus (CN X)

Question 13

What is the nerve supply to the hindgut?;

Answer 13

Sympathetic- Lumbar splanchnic (L1-L2). Parasympathetic- Pelvic splnchnic nerves (S2-4)

Question 14

What nerves contribute to the superior hypogastric plexuses?;

Answer 14

Mainly sympathetic.

Question 15

What nerves contribute to the inferior hypogastric plexuses?;

Answer 15

Mainly parasympathetic.

Question 16

What do the hypogastric plexus and nerves innverate?;

Answer 16

Autonomic function to pelvis- contracts/controls sphincters, uretus, rectum, bladder.