Skip to main content Accessibility help
×
Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-25T04:39:37.192Z Has data issue: false hasContentIssue false

4 - Lumbar Puncture

from SECTION I - NEUROLOGICAL EXAMINATION AND NEURODIAGNOSTIC TESTING

Published online by Cambridge University Press:  06 August 2009

James Valeriano
Affiliation:
Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania
Daniel Ammons
Affiliation:
Department of Emergency Medicine Allegheny General Hospital Pittsburgh, Pennsylvania
Sid M. Shah
Affiliation:
Michigan State University
Kevin M. Kelly
Affiliation:
Drexel University, Philadelphia
Get access

Summary

The only absolute contraindication to performance of a lumbar puncture (LP) is the presence of infection over the puncture site. Potential side effects of lumbar puncture range from minor to life threatening. Even in the absence of infection in the region of the puncture site, there is a risk of introducing an infection into the spinal canal. Strict sterile precautions must therefore be maintained to minimize this risk. Meningitis can develop following LP in a bacteremic patient. D. W. Teele reported that 7 of 46 bacteremic patients developed meningitis following an (initially negative) diagnostic LP. In a patient with equivocal test results and a negative Gram stain, empiric antibiotics therapy is begun until culture results are available. In cases where the examiner has a high pretest probability of bacterial meningitis, the patient should receive appropriate antibiotics before or immediately after LP is performed, without waiting for results to become available.
Type
Chapter
Information
Principles and Practice of Emergency Neurology
Handbook for Emergency Physicians
, pp. 35 - 42
Publisher: Cambridge University Press
Print publication year: 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fedor, H M, Adelman, A M, Pugno, P A, Dallman, J. Meningitis following normal lumbar puncture. J Fam Pract. 1985; 20: 437Google Scholar
Krishra, V, Liu, V, Singleton, A F. Should lumbar puncture be routinely performed in patients with suspected bacteremia? J Nat Med Assoc. 1983; 75: 1153Google Scholar
Sengupta R P, McAllister V L, Gates P. Differential diagnosis. In: Sengupta R D, McAllister V L, eds. Suberachnoid Haemorrhage. Berlin: Springer-Verlag, 1986: 79–92
Swartz, M N, Dodge, P R. Bacterial meningitis – a review of selected aspects, I: general clinical features, special problems and unusual meningial reactions mimicking bacterial meningitis. N Engl J Med. 1965; 272: 725–31, 779–87, 842–8, 898–902Google Scholar
Talan, D A, Guterman, J J, Overturf, G D, Singer, C, Hoffman, J R, Lambert, B. Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med. 1989; 18: 856–62Google Scholar
Teele, D W, Dashefsky, B, Rakusan, T, Klein, J O. Meningitis after lumbar puncture in children with bacteremia. N Engl J Med. 1981; 305: 1079–81Google Scholar
Vermeulen, M, Gijn, J. The diagnosis of subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1990; 53: 365–72Google Scholar
Vermeulen, M, Hasan, D, Blijenberg, B G, Hijdra, A, Gijn, J. Xanthochromia after subarachnoid haemorrhage needs no revisition. J Neurol Neurosurg Psychiatry. 1989; 52: 826–8Google Scholar
Victor M, Ropper A H, Eds. Adams and Victors Principle of Neurology, 7th ed. New York: McGraw Hill; 2001
Weir, B. Headaches from aneurysms. Cephalalgia. 1994; 14: 79–87Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Lumbar Puncture
    • By James Valeriano, Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania, Daniel Ammons, Department of Emergency Medicine Allegheny General Hospital Pittsburgh, Pennsylvania
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book: Principles and Practice of Emergency Neurology
  • Online publication: 06 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547256.005
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Lumbar Puncture
    • By James Valeriano, Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania, Daniel Ammons, Department of Emergency Medicine Allegheny General Hospital Pittsburgh, Pennsylvania
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book: Principles and Practice of Emergency Neurology
  • Online publication: 06 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547256.005
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Lumbar Puncture
    • By James Valeriano, Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania, Daniel Ammons, Department of Emergency Medicine Allegheny General Hospital Pittsburgh, Pennsylvania
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book: Principles and Practice of Emergency Neurology
  • Online publication: 06 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547256.005
Available formats
×