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Lumbar Puncture: Procedure and CSF Analysis

A lumbar puncture involves inserting a thin needle between two lumbar vertebrae to collect cerebrospinal fluid from the spinal canal. First, the back is cleaned and numbed with local anesthetic. Then a needle is inserted and cerebrospinal fluid is withdrawn while measuring pressure. The fluid and pressure measurements can indicate conditions like meningitis, increased intracranial pressure, or normal pressure. The needle is then removed and the site bandaged.

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290 views10 pages

Lumbar Puncture: Procedure and CSF Analysis

A lumbar puncture involves inserting a thin needle between two lumbar vertebrae to collect cerebrospinal fluid from the spinal canal. First, the back is cleaned and numbed with local anesthetic. Then a needle is inserted and cerebrospinal fluid is withdrawn while measuring pressure. The fluid and pressure measurements can indicate conditions like meningitis, increased intracranial pressure, or normal pressure. The needle is then removed and the site bandaged.

Uploaded by

yaneemay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd

Lumbar puncture

• Your back is washed with antiseptic soap or iodine and covered with a sterile sheet.

• During the procedure


• A local anesthetic is injected into your lower back to numb the puncture site before the
needle is inserted. The local anesthetic will sting briefly as it's injected.
• A thin, hollow needle is inserted between the two lower vertebrae (lumbar region), through
the spinal membrane (dura) and into the spinal canal. You may feel pressure in your back
during this part of the procedure.
• Once the needle is in place, you may be asked to change your position slightly.
• The cerebrospinal fluid pressure is measured, a small amount of fluid is withdrawn and the
pressure is measured again. If needed, a drug or substance is injected.
• The needle is removed, and the puncture site is covered with a bandage.
Cerebrospinal Fluid Supernatant Colors and Associated Conditions or Causes

COLOR OF CSF SUPERNATANT CONDITIONS OR CAUSES


Yellow Blood breakdown products
Hyperbilirubinemia
CSF protein ≥150 mg per dL (1.5 g per L)
>100,000 red blood cells per mm3

Orange Blood breakdown products


High carotenoid ingestion
Pink Blood breakdown products
Green Hyperbilirubinemia
Purulent CSF
Brown Meningeal melanomatosis
Causes of elevated opening pressure
• Meningitis: OP can be high particularly in bacterial meningitis, but also can be high in viral and fungal meningitis or neurosyphilis.
• Idiopathic Intracranial Hypertension (IIH): Formerly called pseudotumor cerebri, it causes an elevated OP without any mass
lesions.
• Subarachnoid hemorrhage: Can cause an elevated OP, but it may depend on the timing and severity
• Brain abscesses
• Intracranial vasculitis
• Encephalitis
• Meningeal carcinomatosis: OP can be very high, even as far as overflowing the pressure manometer despite the top extension
piece
• Guillain-Barre syndrome
• Intracranial masses
• Venous sinus thrombosis causing decreased CSF reabsorption
• Jugular vein compression from a neck mass or post-surgical scarring
• Cerebral edema: Could be post-traumatic, from hypoxia, or from a stroke
• Choroid plexus papilloma causing increased CSF production is a rare cause of increased OP
Causes of decrease in opening pressure
• Complete subarachnoid blockage
• Leakage of spinal fluid(post-lumbar puncture, post-traumatic, post-
surgical)
• Severe dehydration
• Hyperosmolality
• Circulatory collapse
Normal opening pressure
• Aseptic meningitis
• Cerebral epidural abscess
• Normal pressure hydrocephalus
• Multiple sclerosis
Contraindications
1. Idiopathic increased intracranial pressure (ICP)
2. Ophthalmoscopy for papilledema
3. Bleeding diathesis (relative)
4. Coagulopathy
5. Decreased platelet count (<50 x 109/L)
6. Infections
7. Skin infection at puncture site
8. Vertebral deformities (scoliosis or kyphosis), in hands of an inexperienced
physician.
• Pressure determination
• Increased CSF pressure can indicate congestive heart failure, cerebral edema,
subarachnoid hemorrhage, hypo-osmolality resulting from hemodialysis, meningeal
inflammation, purulent meningitis or tuberculous meningitis, hydrocephalus, or
pseudotumor cerebri.[22] In the setting of raised pressure (or normal pressure
hydrocephalus, where the pressure is normal but there is excessive CSF), lumbar
puncture may be therapeutic.[22]

• Decreased CSF pressure can indicate complete subarachnoid blockage, leakage of spinal
fluid, severe dehydration, hyperosmolality, or circulatory collapse. Significant changes in
pressure during the procedure can indicate tumors or spinal blockage resulting in a
large pool of CSF, or hydrocephalus associated with large volumes of CSF.

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