User:Mr. Ibrahem/Lumbar puncture
| Mr. Ibrahem/Lumbar puncture | |
|---|---|
.jpg) Lumbar puncture in a sitting position. The reddish-brown swirls on the back are tincture of iodine (an antiseptic). | |
| Other names | Spinal tap |
| Specialty | Neurology |
| Complications | Pain at site, headache, infection, bleeding[1][2] |
| Frequency | Common[3] |
Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF).[3] This can help diagnose meningitis, subarachnoid hemorrhage, and inflammatory disorders of the CNS.[2] These inflammatory disorders include multiple sclerosis, Guillain–Barré syndrome, leukoencephalopathies, and paraneoplastic syndromes.[2] It may also be used treat idiopathic intracranial hypertension and give certain medications.[2]
Contraindications include certain types of increased intracranial pressure, skin infection at the site of puncture, and low platelets under 50 x 109 per L.[3] Though the procedure can be done despite people being on aspirin, or if required clopidogrel; it is not recommended in those on a DOAC or on warfarin with an INR above 1.5.[1] While generally safe, side effects may include pain at the puncture site, post-dural-puncture headache, infection, and bleeding.[1][2] The risk of headache may be reduced by using a small non cutting needle.[5] Very rarely a spinal hematoma or nerve root injury may occur.[1][2]
It is typically performed using local anesthesia and sterile technique.[2] Midazolam or fentanyl may help with anxiety.[4] The procedure is done with the person sitting or on their side.[4] A needle is then advanced in the mid-line or just off mid-line of the back between the L3/4 or L4/5 vertebra into the subarachnoid space and fluid collected.[2][6] A "syringe hickie" can be used to mark the spot.[7] Ultrasound to landmark may increase success.[8]
Following the procedure a bandage is applied and the person may walk around.[2] Fluid is often sent for cell count, microbial culture, protein and glucose levels, color analysis, and cytopathology.[2] Other tests may include PCR testing and oligoclonal bands.[2] Lumbar punctures are commonly carried out.[3] It was first performed in 1891 by the German physician Heinrich Quincke.[2][9]
References[edit]
- ^ a b c d Domingues, R; Bruniera, G; Brunale, F; Mangueira, C; Senne, C (August 2016). "Lumbar puncture in patients using anticoagulants and antiplatelet agents". Arquivos de neuro-psiquiatria. 74 (8): 679–86. doi:10.1590/0004-282X20160098. PMID 27556380.
- ^ a b c d e f g h i j k l m n Doherty, CM; Forbes, RB (May 2014). "Diagnostic Lumbar Puncture". The Ulster medical journal. 83 (2): 93–102. PMC 4113153. PMID 25075138.
- ^ a b c d e Kim, KT (October 2022). "Lumbar puncture: considerations, procedure, and complications". Encephalitis (Seoul, Korea). 2 (4): 93–97. doi:10.47936/encephalitis.2022.00045. PMID 37469996.
- ^ a b c d e f g h i "How To Do Lumbar Puncture - Neurologic Disorders". Merck Manuals Professional Edition. Archived from the original on 27 January 2024. Retrieved 11 March 2024.
- ^ Maranhao, B.; Liu, M.; Palanisamy, A.; Monks, D. T.; Singh, P. M. (2020-12-17). "The association between post‐dural puncture headache and needle type during spinal anaesthesia: a systematic review and network meta‐analysis". Anaesthesia. Wiley. doi:10.1111/anae.15320. ISSN 0003-2409. PMID 33332606.
- ^ "Techniques for Performing Paramedian Approach to Lumbar Puncture". ACEP Now. Archived from the original on 9 February 2023. Retrieved 18 March 2024.
- ^ Issa, EC; Ware, PJ; Bitange, P; Cooper, GJ; Galea, T; Bengiamin, DI; Young, TP (March 2023). "The "Syringe Hickey": An Alternative Skin Marking Method for Lumbar Puncture". The Journal of emergency medicine. 64 (3): 400–404. doi:10.1016/j.jemermed.2023.01.013. PMID 37019501.
- ^ Gottlieb, M; Holladay, D; Peksa, GD (January 2019). "Ultrasound-assisted Lumbar Punctures: A Systematic Review and Meta-Analysis". Academic Emergency Medicine. 26 (1): 85–96. doi:10.1111/acem.13558. PMID 30129102.
- ^ Pearce, JM (February 1994). "Walter Essex Wynter, Quincke, and lumbar puncture". Journal of neurology, neurosurgery, and psychiatry. 57 (2): 179. doi:10.1136/jnnp.57.2.179. PMID 8126500.