Lumbar Puncture: Procedure, Risks, etc.

1. -ALOOR JOISY JOHNSON
3RD YEAR GRP: 36
LUMBAR PUNCTURE ( SPINAL
TAP)
CSF

2. INTRODUCTION
 Lumbar puncture which is also known as spinal
tap is a medical procedure in which a needle is
inserted into a spinal canal most commonly to
collect cerebrospinal fluid (CSF) for diagnostic
testing.
 It is to help diagnose diseases of the central
nervous system which includes brain and spine.

3.  The procedure is typically performed under local
anesthesia using a sterile technique.
 A hypodermic needle is used to access the
subarachnoid space and fluid is collected.

6. CSF ( CEREBROSPINAL FLUID)
 Is a clear, colorless liquid that fills and surrounds
the brain and the spinal cord and provides a
mechanical barrier against shock.
 CSF acts as a cushion or buffer for the brain,
providing basic mechanical
and immunological protection to the brain inside
the skull.
 CSF also serves a vital function in cerebral auto
regulation of cerebral blood flow.

7.  There is about 125–150 ml of CSF at any one
time.
 CSF is present within the subarachnoid space,
which covers the brain, spinal cord, and stretches
below the end of the spinal cord to the sacrum.
 It is produced by the specialized ependymal cells
in the choroid plexuses of the ventricles of the
brain, and absorbed in the arachnoid
granulations.

9. WHY IS IT DONE
A lumbar puncture may be done to:
 Collect cerebrospinal fluid for laboratory analysis
 Measure the pressure of cerebrospinal fluid
 Inject spinal anesthetics, chemotherapy drugs or
other medications
 Inject dye (myelography) or radioactive
substances (cisternography) into cerebrospinal
fluid to make diagnostic images of the fluid's flow

10. INFORMATION GATHERED FROM A
LUMBAR PUNCTURE CAN HELP
DIAGNOSE:
 Serious bacterial, fungal and viral infections,
including meningitis, encephalitis and syphilis
 Bleeding around the brain (subarachnoid
hemorrhage)
 Certain cancers involving the brain or spinal cord
 Certain inflammatory conditions of the nervous
system, such as multiple sclerosis and Guillain-
Barre syndrome

11. WHAT CAN BE EXPECTED:
 A lumbar puncture is usually done in an
outpatient facility or a hospital.
 The doctor will talk about the potential risks, and
any discomfort the one might feel during the
procedure.
 If a child is having a lumbar puncture, a parent is
usually allowed to stay in the room.
 Talk to the child's doctor about whether this will
be possible.

12. BEFORE THE PROCEDURE
 The patient is asked to change into a hospital
gown.
 There are a few possible positions for this test.
Usually, the patient lies on his/her side with
his/her knees drawn up to his/her chest, or sit
and lean forward on a stable surface. These
positions flex the back, widening the spaces
between your vertebrae and making it easier for
the doctor to insert the needle.
 For an infant or young child, someone will hold
the child in position during the procedure.
 The patient’s back is washed with antiseptic soap
or iodine and covered with a sterile sheet.

13. COMMON POSITIONS FOR LUMBAR
PUNCTURE PROCEDURE.

14. DURING THE PROCEDURE
 A local anesthetic is injected into 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.
The patient may feel pressure in the back during
this part of the procedure.
 Once the needle is in place, the patient 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.

15.  The needle is removed, and the puncture site is
covered with a bandage.
 The procedure usually lasts about 45 minutes.
Doctor may suggest lying down after the
procedure.
 Sometimes, an ultrasound may be used as a
guide during the procedure on infants and young
children. The ultrasound can help prevent
inserting the needle too far.

18. RESULTS
The spinal fluid samples are sent to a laboratory for
analysis. Lab technicians check for a number of
things when examining spinal fluid, including:
 General appearance: Spinal fluid is normally
clear and colorless. If it's cloudy, yellow or pink in
color, it might indicate abnormal bleeding. Spinal
fluid that is green might indicate an infection or
the presence of bilirubin.
 Protein (total protein and the presence of
certain proteins): Elevated levels of total protein
greater than 45 milligrams per deciliter (mg/dl)
may indicate an infection or another inflammatory
condition. Specific lab values may vary from
medical facility to medical facility.

19.  White blood cells: Spinal fluid normally contains
up to 5 mononuclear leukocytes (white blood
cells) per micro liter. Increased numbers may
indicate an infection. Specific lab values may vary
from medical facility to medical facility.
 Sugar (glucose): A low glucose level in spinal
fluid may indicate infection or another condition.
 Microorganisms: The presence of bacteria,
viruses, fungi or other microorganisms can
indicate an infection.
 Cancer cells: The presence of abnormal cells in
spinal fluid such as tumor or immature blood cells
can indicate certain types of cancer.

20. RISKS
Though lumbar punctures are generally recognized
as safe, they do carry some risks. These include:
 Post-lumbar puncture headache: Up to 25 % of
people who have undergone a lumbar puncture
develop a headache afterward due to a leak of
fluid into nearby tissues. It typically starts several
hours up to two days after the procedure and may
be accompanied by nausea, vomiting and
dizziness. Are usually present when sitting or
standing and resolve after lying down. Post-
lumbar puncture headaches can last from a few
hours to a week or more.
 Back discomfort or pain: You may feel pain or
tenderness in your lower back after the
procedure. The pain might radiate down the back
of your legs.

21.  Bleeding: Bleeding may occur near the puncture
site or, rarely, into the epidural space.
 Brainstem herniation: Increased pressure within
the skull (intracranial), due to a brain tumor or
other space-occupying lesion, can lead to
compression of the brainstem after a sample of
cerebrospinal fluid is removed.
 A computerized tomography (CT) scan or MRI
prior to a lumbar puncture can be obtained to
determine if there is evidence of a space-
occupying lesion that results in increased
intracranial pressure. This complication is rare.

22. MENINGITIS
 Meningitis is an inflammation of the membranes
(meninges) surrounding the brain and spinal cord.
 The swelling from meningitis typically triggers
symptoms such as headache, fever and a stiff
neck.
 Are caused by a viral infection, but bacterial,
parasitic and fungal infections are other causes.
 Spinal tap (lumbar puncture): For a definitive
diagnosis of meningitis, one needs a spinal tap to
collect cerebrospinal fluid (CSF). In people with
meningitis, the CSF often shows a low sugar
(glucose) level along with an increased white
blood cell count and increased protein.

24. MULTIPLE SCLEROSIS
 Is a demyelinating disease in which
the insulating covers of nerve cells in
the brain and spinal cord are damaged. This
damage disrupts the ability of parts of the
nervous system to communicate, resulting in a
range of signs and symptoms, including
physical, mental, and sometimes psychiatric
problems.
 Specific symptoms can include double
vision, blindness in one eye, muscle weakness,
trouble with sensation, or trouble with
coordination.

25. RESULTS OF S[INAL TAP IN MULTIPLE
SCLEROSIS:
 Presence of oligoclonal bands, a group of
proteins (called immunoglobulins) that show
inflammation in the central nervous system.
 High levels of immunoglobulin G (IgG) antibodies.
People with low levels of IgG are more prone
to infections.
 Other proteins resulting from the breakdown of
myelin (the fatty substance that surrounds and
protects nerve cells) may also be present.

27. SUBARACHNOID
HEMORRHAGE
 Is bleeding into the subarachnoid space the area
between the arachnoid membrane and the pia
mater surrounding the brain.
 Symptoms may include a severe headache of
rapid onset, vomiting, decreased level of
consciousness, fever, and sometimes seizures.

28.  Lumbar puncture is regarded mandatory in
people with suspected SAH if imaging is
negative. At least three tubes of CSF are
collected. If an elevated number of red blood
cells is present equally in all bottles, this indicates
a subarachnoid hemorrhage.
 If the number of cells decreases per bottle, it is
more likely that it is due to damage to a small
blood vessel during the procedure (known as a
"traumatic tap").

30. GUILLAIN-BARRE SYNDROME
 Is a rapid-onset muscle weakness caused by
the immune system damaging the peripheral
nervous system.
 The initial symptoms are typically changes in
sensation or pain along with muscle weakness,
beginning in the feet and hands.
 Spinal tap: An elevated protein level, usually
greater than 0.55 g/L, and fewer than 10 white
blood cells per cubic millimeter of fluid ("albumin
cytological dissociation").Elevated CSF protein
levels are found in approximately 50% of patients
in the first 3 days after onset of weakness, which
increases to 80% after the first week.

31. IDIOPATHIC INTERCRANIAL
HYPERTENSION
 Is a condition characterized by
increased intracranial pressure (pressure around
the brain) without a detectable cause.
 The main symptoms are headache, vision
problems, ringing in the ears with the heartbeat,
and shoulder pain. Complications may
include vision loss.
 Spinal tap: The first step in symptom control is
drainage of cerebrospinal fluid by lumbar
puncture. If necessary, this may be performed at
the same time as a diagnostic LP (such as done
in search of a CSF infection). In some cases, this
is sufficient to control the symptoms, and no
further treatment is needed.

33. BRAIN OR SPINAL CORD
TUMORS
 Lumbar punctures usually aren’t done to
diagnose brain tumors, but they may be done to
help determine the extent of a tumor by looking
for cancer cells in the CSF. They are often used if
a tumor has already been diagnosed as a type
that can commonly spread through the CSF, such
as an ependymoma.
 Lumbar punctures are particularly important in
people with suspected brain lymphomas because
often the lymphoma cells spread into the CSF.

35. THANKYOU