neurologic disorders
How To Do Lumbar Puncture
Contraindications
Absolute contraindications Suspected infection (eg, cellulitis, abscess) at or near the site of needle insertion: If possible, use an alternate, uninfected site. This involves a suboccipital (cisternal) or cervical (C1-C2) approach and is always done under fluoroscopic guidance. Relative contraindications Suspicion of increased intracranial pressure due to an intracranial mass (eg, tumor, brain abscess, or blood) that could precipitate transtentorial or cerebellar Brain Herniation * following lumbar puncture. If there are suggestive findings (eg, focal neurologic deficits, altered mental status, papilledema, Overview of Coagulation Disorders (eg, international normalized ratio [INR] Cardiopulmonary insufficiency or respiratory distress, which can be exacerbated by recumbent positioning during lumbar puncture Anatomic abnormalities at the insertion site (eg, spinal fusion, laminectomy, congenital anomalies) Bacteremia has not been shown to predispose to meningitis after lumbar puncture and thus is not a contraindication. * When lumbar puncture is deferred, begin treatment of suspected Treatment or † Therapeutic anticoagulation (eg, for pulmonary embolism) increases the risk of bleeding with lumbar puncture, but this must be balanced against the increased risk of thrombosis (eg, stroke) if anticoagulation is reversed. If time permits, discuss any contemplated reversal with the clinician managing the patient's anticoagulation. 