LUMBAR PUNCTURE

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LUMBAR PUNCTURE (Spinal Tap). An invasive procedure to gain access into the sub-arachnoid space. Just as the cisternal

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LUMBAR PUNCTURE

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1. LUMBAR PUNCTURE DR. OGUNDARE E. O

2. LUMBAR PUNCTURE (Spinal Tap) An invasive procedure to gain access into the sub-arachnoid space. Just as the cisternal & ventricular taps May be diagnostic & At times therapeutic.

3. The Normal CSF Pressure: 50 - 180 mmH2O Appearance: clear, colourless (Xanthochromic in NN) CSF total protein: 15 - 45 mg/ 100 ml Gamma globulin: 3 - 12% of the total protein CSF glucose: 50 - 80 mg/ 100 ml (or approximately 1/2 - 2/3 of serum glucose level) CSF cell count: 0 - 5 white blood cells (WBC), no red blood cells (RBC) Chloride: 110 - 125 mEq/ L

4. Indications Performed in order to: Collect CSF samples for biochemical, microbiological and cytological analysis, Instill intra-thecal drugs e.g. Methotrexate. or rarely to relieve raised ICP.

5. Indications: Diagnostic Infections: meningitis (bacterial, viral, TB, fungal e.t.c) Encephalitis Subarachnoid haemorrhage CNS diseases: Guillain-Barre syndrome, Carcinomatous meningitis Staging of tumours: Stage D burkitt’s Instillation: Dye injection for myelography CSF pressure measurement

6. Indications: Therapeutic Drug Instillation: chemotherapeutic agents Spinal anaesthesia Therapeutic relief of: Benign ICP hypertension (Pseudotumor cerebri) Hydrocephalus

7. Understanding LP Spinal Anatomy Positions Equipment

8. ANATOMY Bones: spinal column has 2 anterior concave curves-in thoracic & lumbar regions. Ligaments Foramen : interlaminar foramen The Meninges & the Spaces

9. Positioning Sitting Good for certain patients: Obese pulmonary disorder Newborn/ infants – prevents hyperflexion

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