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The Nervous System: Pathology > Lumbar Puncture > Flashcards

Lumbar Puncture Flashcards

1
Q

A lumbar puncture is needed to obtain CSF for the diagnosis of what 7 things

A

Meningitis

Meningoencephalitis

Subarachnoid haemorrhage

Malignancy – diagnosis and treatment

Idiopathic Intracranial Hypertension

Other neurologic syndromes

Infusion of Drugs or contrast

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2
Q

When must a lumbar puncture not take place

A

Unstable patient with cardiovascular or respiratory instability

Localized skin/soft tissue infection over puncture site

Evidence of unstable bleeding disorder

Increased intracranial pressure

Chiari malformation - be cautious

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3
Q

When can neurological deterioration occur in a lumbar puncture

A

If LP is done below the level of complete spinal subarachnoid block

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4
Q

What must be performed before a lumbar puncture if there is suspected increased intracranial pressure

A

Head CT

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5
Q

What are the three position approaches for lumbar puncture

A

Lateral decubitus approach

sitting position

Paramedia approach

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6
Q

Where should a lumbar puncture take place

A

L3 - L4
L4 - L5

so is below where the spinal cord ends at L1-L2

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7
Q

What is the positioning of lateral decuticus approach

A

maximally flex spine without compromising airways
keep alignment of feet, knees and hips
Position head to left if right handed etc

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8
Q

What is the step procedure of a lumbar puncture

A 
Aseptic technique – clean skin with betadine
Local anaesthetic
Spinal needle, angled towards umbilicus
Aim for interlaminar space through ligamentum flavum
Feel for ‘a give’ after lig. flavum
Check for CSF
Measure pressure
Obtain samples
Withdraw needle
Dressing to cover entry site
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9
Q

Why does manometry occur in LP

A

To obtain opening and potential closing pressure

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10
Q

What position can pressure only be accurately measured with manometry in a lumbar puncture

A

Lateral debuticus postion

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11
Q

What is the CSF for in each of the three vials

A
  1. culture and fram stain
  2. glucose and protein
  3. cell count and differential
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12
Q

When is the sitting position lumbar puncture carried out

A

In infants

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13
Q

When is paramedic lateral approach lumbar puncture carried out

A

Patients who have calcification from repeated LP

Patients with anatomical abnormalities

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14
Q

What is the benefit of paramedical approach,

A

spinal headache is less because the holes through the dura and arachnoid tissue do not overlap

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15
Q

What is additional indications for lumbar punctures

A

Measurement of pressure

CSF drainage for raised pressure

diagnostic test for normal pressure hydrocephalus

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16
Q

What needs to be check before a lumbar puncture takes place

A

Awake & conscious patient

No focal neurological deficit (6th nerve palsy)

CT/MRI: rule out intracranial mass lesion

Ensure patient not on anticoagulants

17
Q

What is the main risks of lumbar puncture

A

Bleeding

Infection

Nerve root injury

Retroperitoneal /
intra-abdominal injury

Brainstem herniation

18
Q

What is the complication of lumbar puncutre

A

Headache
Backpain
Subarachnoid epidermal cysts

19
Q

What is the procedure if brainstem herniation occurs in lumbar puncture

A

Remove needle

Raise bed to improve venous return from the brain

20
Q

What is performed if suspected subdural heamatoma

A

CT

21
Q

What is performed is suspected epidural haemtoma

A

MRI spine

22
Q

What is the signs of meningitis in the CSF

A

Cloudy, turbid
WBC - lots!! – mostly polymorphs
Protein >1g/l
Glucose - low

23
Q

If the CSF is bloody what does this indicate

A

Traumatic tap

Following SAH

24
Q

What does it indicate if CSF is yellow - Xanthochromic

A

Yellow due to blood breakdown products

Most commonly seen in SAH

25
Q

What helps a bilateral spinal headache

A

Supine postion
Hydration
caffeine
Epidural blood pattch

26
Q

What is the best prevention of a spinal headache

A

passing needle beval parallel to longitudinal fibres of dura

replacing sytlet before removing needle

using small diameter needles or atraumatic needles

bed rest

27
Q

If fail to complete procedure

A

ask someone else

radiographic guided procedure

bedside ultrasound

28
Q

Why is indication for CT scanning before lumbar puncture

A

Focal neurological deficit - not including cranial nerve palsies

New onset seizures

Papilloedema

Abnormal level of consciousness

severe immunocompromised state

29
Q

What is contradiction for a lumbar puncture

A

Focal symptoms suggesting a focal brain mass

Reduced conscious level suggesting intracranial pressure

Cranial nerve palsy

30
Q

Why do you no perform a lumbar puncture when there are signs and symptoms to suggest an intracranial mass lesion

A

You might cause meningitis
You might cause a herniation syndrome and the patient could die
You might cause an air embolism
You might make the patient’s headache worse

The Nervous System: Pathology (25 decks)

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