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					LUMBAR PUNCTURE

Indications
 Diagnostic  Therapeutic  Radiological  Anaesthetic

Diagnostic
Suspected intracranial infections - bacterial or viral meningitis, - increase in lymphocytes Suspected subarachnoid haemorrhage - in trauma Pressure measurement Peripheral nerve disease – GB Syndrome - ascending paralysis

Therapeutic
 Inj.Methotrexate

in acute lymphatic

leukemia  Inj.Crystalline penicillin in pyogenic meningitis  Inj.Hydrocortisone in TB meningitis

Anaesthetic
 Inj.Lignocaine

50mg & Bupivacaine 1% in spinal anaesthesia

Radiological
 To


do a myelogram

Rarely used b/c contra CT scan is

Contraindications
 Raised
 

intracranial pressure (papilloedma)

Herniation will happen An absolute contraindication

in skin  Bleeding disorders  Gross spinal lesion


 Sepsis

Severe kyphosis or scoliosis

Site
between L3 – L4  Children - L4 – L5
 Space


b/c spinal cord ends lower in children

 Subarachnoid

space

Anatomical layers punctured during LP
       



Skin Subcutaneous tissue Supraspinatous ligament Interspinous ligament Ligamentum flavum Extradural fat Duramatter Subdural space Arachnoid matter

Equipments
 Lumbar

puncture needle – can cause an epidermal cyst b/c carries skin tissue into CSF

Site of puncture

Site of puncture

Complications
 Headache
 

–

Ask patients to drink lots of water, give asprin Raise feet above head to avoid leaking

 Backache  Infection

to blood vessels, spinal cord &IVD  Root pain due to puncture of nerve root  Transtentorial herniation  6th nerve palsy – 1st nerve to be affected b/c of its long course.

 Trauma



THANK YOU


				
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posted:9/26/2008
language:English
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