lumbar puncture

Question 1

who to you have to discuss LP wth

Answer 1

ED consultant or senior doctor

Question 2

how to coucel patient

Answer 2

sterilise lower bakc
insert a small needle into the slace between bones and back
drops of spinal fluid are collected and sent to the laboritory

Question 3

serious complications of LP

Answer 3

spinal cord damage, nerve damaage, bleeding and infection

Question 4

what happens after LP

Answer 4

child may complain of headache or back ache - may be offered paracetamol
child will have a small dresing on lower back for 24 hours

Question 5

what should you do before LP

Answer 5

a capillary/venous blood glucose level should be obtained immidiately before the procedure for comparison with CSF glucose

Question 6

indications for LP

Answer 6

suspected meningitis or encephalitis
suspected sub-arachnoid with normal CT
measurement of opening pressure in supetced idiopathic intracranial hypertension
therapeutic reduction in ICP in iidiopathic intracranial hypertension
diagnosis of neuroinflammatory disorders

Question 7

contraindications

Answer 7

coma or decreased concious state
ssigns of raised ICP
in post seizure state
new focal neurological signs
suspected DIC/purpuric rash
local infection
coagulation defects
cardiovascular compromise/shock
respiratory compromise
thrombocytopaenia

Question 8

should patients mobilise after LP

Answer 8

yes

Question 9

what to put on the pathology request for CSf

Answer 9

CSF MC&S
CSF protein and glucose
CSF PCR panel if:
- all infants <28 days
- if WCC is above 5 cells per mm3
- on request for clinical suspicion of meningitis

Question 10

CSF PCR panel includes

Answer 10

bacteria: E coli, haemophilus influenzae, listeria monocytogenes, neisseria meningitidis, streptococcus agalactiae, streptococcus pnuemoniae
viruses: CMV, enterovirus, HSV 1 and 2, HHV6, HPeV, VZV
fungi: cryptococcus neoformans/gattii

Question 11

complications of lumbar puncture

Answer 11

headaches common
backaches
transient/persistant parasthesia/numbness
cerebral herniation (bradycardias, apnoeas, O2 desats)
subdural haemorrhages
paraplegia
infections
cardiorespiratory compromise due to positioning (neck flexed too much)

Question 12

bacterial meningitis picture

Answer 12

high neutrophils
slightly raised lymphocytes
high protein
low glucose

Question 13

viral meningitidis picture

Answer 13

slightly raised neutrophils
raised lymphocytes
normal glucose and protien

Question 14

partally treated bacterial meningitis

Answer 14

may look more like viral meningitis or a combination of both