Spinal Puncture

SPINAL PUNCTURE REASON FOR VISIT •Meningitis •Subarachnoid hemorrhage

•Headache •Neck stiffness •Irritability •Swelling of the fontanelle

•Vertigo •Seizures

•Vomiting •Paralysis •Paraplegia •Hydrocephalus •Papilledema •Benign intracranial hypertension •Spinal anesthesia

•Chemotherapy •Cerebral edema •Transient visual obscurations •Hypo-osmolality resulting from hemodialysis •Tuberculous meningitis •Pseudotumor cerebri •Complete subarachnoid blockage

RISK ASSESSMENT •Idiopathic (unidentified cause) increased intracranial pressure (ICP)

•Coagulopathy •Decreased levels of platelets in the blood

•Bleeding disorders •Heart diseases •Diabetes •Hypertension •Allergy to medication •Allergy to anesthesia •Infection at the site of needle insertion PREPARATION OF THE PATIENT •Blood tests

•Urinalysis •Chest X-ray •ECG •CT scan brain •MRI •blood thinning medication was stopped •Part was prepared and draped

ANESTHESIA Local anesthesia POSITION OF THE PATIENT •Left/ Right lateral position with neck bent in full flexion and knees

bent in full flexion up to chest •Sitting position on a stool with bending the head and shoulders

forward

THE PROCEDURE •The area around the lower back was prepared using aseptic

technique and draped •A spinal needle was inserted between the lumbar vertebrae L3/L4

or L4/L5 and pushed in until there was a "give" that indicates the needle was past the dura mater. •The stylet from the spinal needle was withdrawn and drops of

cerebrospinal fluid are collected. •A fingerstick/ venipuncture at the time of lumbar puncture were

performed to assess peripheral glucose levels in order to determine a predicted CSF glucose value. •The opening pressure of the cerebrospinal fluid was taken during

this collection by using a simple column manometer. •The needle was withdrawn while placing pressure on the puncture

site. AFTER PROCEDURE The samples were sent for histopathological study FINDINGS Diagnostics •Increased CSF pressure was noted during procedure which

indicates congestive heart failure/ cerebral edema/ subarachnoid hemorrhage/ hypo-osmolality resulting from hemodialysis/ meningeal inflammation/ purulent meningitis/ tuberculous meningitis/ hydrocephalus/ pseudotumor cerebri.

•Decreased CSF pressure was noted which indicates complete

subarachnoid blockage/ leakage of spinal fluid/ severe dehydration/ hyperosmolality/ circulatory collapse •Granulocytes/ White cells were present •Chloride levels are_____ •Glucose is ___% •Glutamine levels are _______ •Lactate levels •Lactate dehydrogenase levels •total protein content of cerebrospinal fluid ______ •IgG levels

DURATION ____min POSTOPERATIVE CARE •Take antibiotics as prescribed •Take pain medication as prescribed

COMPLICATIONS •Headache with nausea •Paresthesia •Spinal or epidural bleeding •Trauma to the spinal cord or spinal nerve roots

•Weakness •Loss of sensation

•Paraplegia •Perforation of abnormal dural arterio-venous malformations

•Infection

•Spinal cord compression •Cerebral herniation