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INDICATIONS

CONTRAINDICATIONS

ANATOMY

SURGICAL PLANES

EQUIPMENT

PROCEDURE

SPECIMENS

COMPLICATIONS

TREATMENT

QUIZ

1. Indications

Lumbar Puncture (LP) is primarily indicated for the evaluation and diagnosis of patients who present with symptoms consistent with:

• Meningitis

• Meningoencephalitis

• Subarachnoid hemorrhage

Other neurologic indications include:

• Malignancy

• Seizures

• Metabolic or Degenerative diseases

LP Indications in Neonates (Children less than 1 year of age):

• Sepsis evaluation.

• Febrile children with suspected bacteremia.

• Those children too young for accurate clinical evaluation of meningitis.

• Apparent febrile seizure.

• Mental status change with no identifiable cause.

Additional Uses of LP:

• Management of patients with Pseudotumour Cerebri.

• Administration of intrathecal antibiotic therapy.

• Instillation of chemotherapeutic agents.

2. SPECIAL  CASES

1. In suspected cases of Tuberculosis meningitis send CSF for polymerase chain reaction, which is a rapid and sensitive test.

2. Send a CSF Venereal Disease Research Laboratories (VLDR) reagent from patients with a positive serum treponemal test result with possible neurosyphilis or from neonates delivered to mothers with positive results for serum VLDR or rapid protein reaction (either without history of prior treatment or with treatment failure) in order to exclude congenital syphilis.  

3. Computed tomography is indicated before LP in the patient with suspected acute bacterial meningitis who has symptoms suggestive of significantly increased intercranial pressure.