Introduction to Clinical Skills: Lumbar Puncture

1. Introduction to Clinical Skills:Lumbar Puncture Gregory Gruener, M.D. Department of Neurology

2. Considerations • Why is an LP Being Done? • Is this the Only Test Available? • What Positive Information is Expected? • Is the Patient Stable?

3. Indications • Diagnostic • Infection • Subarachnoid Hemorrhage • Multiple Sclerosis • Therapeutic • Neoplasm • Incidental • Myelography

4. Contraindications • Suspected Increase in ICP • Suspected Spinal Cord Compression • Infection at the Site of an LP • Coagulopathy

5. Normal CSF Values • Appears to be clear and colorless • Opening Pressure ~ 120 mm/H20 • Protein level ~ 35 mg% • Glucose level ~ 60 mg % • (60% of serum glucose) • Cells < 5 lymphocytic/monocytic

6. CSF Profile’s

7. Proper Positioning(one)

8. Proper Positioning(two)

9. Preparation for the LP(one)

10. Preparation for the LP(two)

11. Injection of the skin

12. Proper Positioning(one)

13. Proper Positioning(two)

14. Incorrect Position(one)

15. Incorrect Position(two)

17. Alternative Techniques • Sitting Position • Radiological Guidance • Cisternal Tap • Cervical Tap • Lumbar Puncture Technique in Neonates and Infants

18. Complications • Headache (Post LP Headache) • Painful Paresthesias • Persistent Pain or Paresthesias • Spinal Hematoma • Spinal Infection • Herniation

19. CSF Leak(one)

20. CSF Leak(two)

21. Complications • Headache • Painful Paresthesias • Persistent Pain or Paresthesias • Spinal Hematoma • Spinal Infection • Herniation

22. Complications • Headache • Painful Paresthesias • Persistent Pain or Paresthesias • Spinal Hematoma or a Bloody Tap • Spinal Infection • Herniation

23. “Bloody Tap”

24. Complications • Headache • Painful Paresthesias • Persistent Pain or Paresthesias • Spinal Hematoma • Spinal Infection • Herniation

25. Complications • Headache • Painful Paresthesias • Persistent Pain or Paresthesias • Spinal Hematoma • Spinal Infection • Herniation (Brain not the disc)