Lumbar Puncture

ABSTRACT

Lumbar puncture is the original neurological procedure. The technique is learned by the student first through observation then performance under supervision by a physician who has mastered the technique. It is one of the more difficult procedures in medicine because success is not only dependent on the skill of the physician but also the size, anatomy, and comfort of the patient. The technique, complications, contraindications, and treatment of the complications are reviewed. A discussion of the composition of normal cerebrospinal fluid (CSF) is included, as well as tables for diagnostic CSF studies for infectious, inflammatory, and neoplastic central nervous system disorders.

KEYWORDS

Lumbar puncture

REFERENCES

• 1 Fishman R A. Examination of the cerebrospinal fluid: techniques and complications. In: Fishman RA, ed. Cerebrospinal Fluid in Diseases of the Nervous System 2nd ed. Philadelphia: WB Saunders 1992: 157-182
• 2 Hart J R, Whitacre R J. Pencil-point needle in prevention of postspinal headache.  JAMA . 1951;  147 657-658
• 3 Sprotte G, Schedel R, Pajunk H. Eine "atraumatische" Universalkanule fur einzeitige Regionalanasthesien.  Reg Anesth . 1987;  10 104-108
• 4 Evans R W, Armon C, Frohman E M, Goodin D S. Assessment: prevention of post-puncture headaches. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology . 2000;  55 909-914
• 5 Evans R W. Complications of lumbar puncture.  Neurol Clin North Am . 1998;  16 83-105
• 6 Strupp M, Brandt T, Muller A. Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients.  J Neurol . 1998;  245 589-592
• 7 McDonald J V, Klump T E. Intraspinal epidermoid tumors caused by lumbar puncture.  Arch Neurol . 1986;  43 936-939
• 8 Dieterich M, Perkin G D. Postlumbar puncture headache syndrome. In: Brandt T, Caplan LR, Dichland J, et al, eds. Neurological Disorders: Course and Treatment San Diego: Academic Press 1996: 59-63
• 9 Muller B, Adelt K, Reichman H, Toyka K. Atraumatic needle reduces the incidence of post-lumbar puncture syndrome.  J Neurol . 1994;  241 376-380
• 10 Braune H-J, Huffmann G. A prospective double-blind clinical trial, comparing the sharp Quincke needle (22G) with an "atraumatic" needle (22G) in the induction of post-lumbar puncture headache.  Arch Neurol Scand . 1992;  86 50-54
• 11 Kleyweg R P, Hertzberger L I, Carbaat P AT. Significant reduction in post-lumbar puncture headache using an atraumatic needle: a double-blind, controlled clinical trial.  Cephalalgia . 1998;  18 635-637
• 12 Tarkkila P J, Miralles J A, Palomaki E A. The subjective complications and efficiency of the epidural blood patch in the treatment of postdural puncture headache.  Reg Anesth . 1989;  14 247-250
• 13 Berrettini W H, Simmons-Alling S, Nurnberger J I. Epidural blood patch does not prevent headache after lumbar puncture.  Lancet . 1987;  1 856-857
• 14 Loeser E A, Hill G E, Bennett G M, Sederberg J E. Time and bed rest as a function of success in epidural blood patch for post lumbar puncture headache.  Anesthesiology . 1978;  49 147-161
• 15 Sihota M K, Denny N, Pearson D, Reed J, Selander D. Post-spinal headache after continuous anesthesia: a prospective data-based study.  Reg Anesth . 1987;  12 54-55
• 16 Peterson O D, Borup J L, Chestnut J S. Continuous spinal anesthesia.  Reg Anesth . 1985;  8 109-113
• 17 Spriggs D A, Burn D J, French J, Cartlidge N EF, Bates D. Is bed rest useful after diagnostic lumbar puncture?.  Postgrad Med J . 1992;  68 581-583
• 18 Corbett J J, Mehta M P. Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri.  Neurology . 1983;  33 1386-1388
• 19 Fishman R A. Composition of the cerebrospinal fluid. In: Fishman RA, ed. Cerebrospinal Fluid in Diseases of the Nervous System Philadelphia: WB Saunders 1992: 183-252
• 20 DeAngelis L M, Cairncross J G. A better way to find tumor in the CSF?.  Neurology . 2002;  58 339-340
• 21 Gleissner B, Siehl J, Korfel A, Reinhardt R, Thiel E. CSF evaluation in primary CNS lymphoma patients by PCR of the CDR III IgH genes.  Neurology . 2002;  58 390-396
• 22 Andersson M, Alvarez-Cermeno J, Bernardi G, Cogato I. et al . Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report.  J Neurol Neurosurg Psych . 1994;  57 897-902
• 23 Olsson T. Cerebrospinal fluid.  Ann Neurol . 1994;  36 S100-S102
• 24 Pirttila T, Nurmikko T. CSF oligoclonal bands, MRI, and the diagnosis of multiple sclerosis.  Acta Neurol Scand . 1995;  92 468-471
• 25 Burkhard P R, Sanchez J C, Landis T, Hochstrasser D F. CSF detection of the 14-3-3 protein in unselected patients with dementia.  Neurology . 2001;  56 1528-1533
• 26 Prusiner S B. Shattuck lecture: neurodegenerative diseases and prions.  N Engl J Med . 2001;  344 1516-1551
• 27 Demaerel P, Heiner L, Robberecht W, Sciot R, Wilms G. Diffusion-weighted MRI in sporadic Creutzfeldt-Jakob disease.  Neurology . 1999;  52 205-208