Lumbar Puncture

doi:10.1017/CBO9780511547256.005

4 - Lumbar Puncture

from SECTION I - NEUROLOGICAL EXAMINATION AND NEURODIAGNOSTIC TESTING

Published online by Cambridge University Press: 06 August 2009

James Valeriano and

Daniel Ammons

Edited by

Sid M. Shah and

Kevin M. Kelly

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James Valeriano: Affiliation:
Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania
Daniel Ammons: Affiliation:
Department of Emergency Medicine Allegheny General Hospital Pittsburgh, Pennsylvania
Sid M. Shah: Affiliation:
Michigan State University
Kevin M. Kelly: Affiliation:
Drexel University, Philadelphia

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Summary

The only absolute contraindication to performance of a lumbar puncture (LP) is the presence of infection over the puncture site. Potential side effects of lumbar puncture range from minor to life threatening. Even in the absence of infection in the region of the puncture site, there is a risk of introducing an infection into the spinal canal. Strict sterile precautions must therefore be maintained to minimize this risk. Meningitis can develop following LP in a bacteremic patient. D. W. Teele reported that 7 of 46 bacteremic patients developed meningitis following an (initially negative) diagnostic LP. In a patient with equivocal test results and a negative Gram stain, empiric antibiotics therapy is begun until culture results are available. In cases where the examiner has a high pretest probability of bacterial meningitis, the patient should receive appropriate antibiotics before or immediately after LP is performed, without waiting for results to become available.

Keywords

bacterial meningitis empiric antibiotics Gram stain infection spinal canal lumbar puncture

Type: Chapter
Information: Principles and Practice of Emergency Neurology
Handbook for Emergency Physicians
, pp. 35 - 42

DOI: https://doi.org/10.1017/CBO9780511547256.005 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2003

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References

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4 - Lumbar Puncture

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