Lumbar Puncture

A lumbar puncture (LP) or spinal tap may be washed to diagnose or treat a condition. For this procedure, your healthcare provider inserts a hollow needle into the space surrounding the spinal cavalcade (subarachnoid space) in the lower back to withdraw some cerebrospinal fluid (CSF) or inject medicine.

CSF is a clear fluid that bathes and cushions the brain and spinal string. It is continuously made and reabsorbed in the brain. CSF is fabricated up of cells, water, proteins, sugars, and other substances that are essential to maintain balance in the nervous system.

Why might I need a lumbar puncture?

A lumbar puncture may be done for various reasons. The most mutual reason is to remove a pocket-sized amount of CSF for testing. This tin help in the diagnosis of various disorders. The fluid is tested for red and white blood cells, poly peptide, and glucose (sugar). The clarity and color of the fluid are too checked and information technology is tested to come across whether leaner, viruses, or abnormal cells are nowadays. Backlog CSF may besides be removed in people who have an overproduction or decreased absorption of the fluid.

A lumbar puncture process may be helpful in diagnosing many diseases and disorders, including:

  • Meningitis. An inflammation of the membrane covering the brain and spinal cord. The inflammation is usually the effect of a viral, bacterial, or fungal infection.

  • Encephalitis. An inflammation of the brain that is usually caused by a virus.

  • Certain cancers involving the encephalon and spinal string

  • Haemorrhage in the surface area between the brain and the tissues that cover it (subarachnoid space)

  • Reye syndrome. A sometimes fatal disease that causes astringent issues with the brain and other organs. Although the exact cause of the disease is not known, it has been linked to giving aspirin to children. It is at present advised not to give aspirin to children during illnesses, unless prescribed past your child's healthcare provider.

  • Myelitis. An inflammation of the spinal cord or bone marrow.

  • Neurosyphilis. A stage of syphilis during which the leaner invades the central nervous system.

  • Guillain-BarrĂ© syndrome. A disorder in which the body'south allowed organization attacks role of the nervous system.

  • Demyelinating diseases. Diseases that attack the protective coating that surrounds certain nerve fibers - for case, multiple sclerosis or acute demyelination polyneuropathy.

  • Headaches of unknown crusade. After evaluation and head imaging if necessary, a lumbar puncture may be washed to diagnose certain inflammatory weather that can event in a headache.

  • Pseudotumor cerebri (also called idiopathic intracranial hypertension, or IIH). In this condition,pressure within the subarachnoid space is elevated for reasons that are non clear. A lumbar puncture is merely washed in this status after evaluation and caput imaging.

  • Normal pressure hydrocephalus. A rare condition affecting mainly older people in which in that location is a triad of loss of urinary control, memory problems, and an unsteady gait. A lumbar puncture is done to see if the pressure of the CSF is elevated or not.

In addition, a lumbar puncture may be used to measure the pressure of the CSF. The healthcare provider uses a special tube (called a manometer) to measuresouthward the force per unit area during a lumbar puncture.

Finally, a lumbar puncture may be done to inject medicine directly into the spinal cord. These include:

  • Spinal anesthetics before a surgical procedure
  • Contrast dye for X-ray studies - for example, myelography
  • Chemotherapy drugs used to treat cancer

Your healthcare provider may have other reasons to recommend a lumbar puncture.

Pseudotumor Cerebri | Ashley's Story

After visiting 30+ physicians, Ashley was diagnosed with the rare condition known as pseudotumor cerebri. She and her family turned to the experts at Johns Hopkins who worked equally a team to implant a stent, a new approach to treating this condition that is typically treated with a shunt.

What are the risks of a lumbar puncture?

Considering this procedure involves the spinal cord and brain, the post-obit complications may occur:

  • A small amount of CSF can leak from the needle insertion site. This can crusade headaches later the process. If the leak continues, your headache can be severe.
  • You may have a slight chance of infection considering the needle breaks the skin's surface, providing a possible way for bacteria to enter the body.
  • Short-term numbness of the legs or lower back hurting may be experienced.
  • hither is a risk of haemorrhage in the spinal canal.

There may exist other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How practise I fix for a lumbar puncture?

I f y'all are having a lumbar puncture at Johns Hopkins Hospital or Bayview Medical Heart, a neuroradiologist or radiology nurse will contact you by phone two or three days prior to your lumbar puncture to hash out the procedure and answer any questions you may have.

Delight inform the neuroradiology dr. if:

  • Yous are on antibiotics - you may need to wait to practice the procedure if currently on antibiotics for an in infection in your blood. If you accept an agile infection or fever, your procedure may need to exist rescheduled.
  • You are allergic to any local anesthetics (lidocaine)
  • There is any risk that you could be significant
  • Y'all are on anticoagulant therapy (blood thinners)

PRECAUTIONS : If you lot are pregnant or think yous might be pregnant, please check with your doctor before scheduling the exam. Other options should exist discussed with you and your medico.

Habiliment : You may be asked to change into a gown. A gown will be provided for you. Yet, the process may also be washed while you remain in your clothes from domicile. For this reason, try to wear non-restrictive, comfortable article of clothing and sideslip on shoes if possible. Please remove all piercings and leave all jewelry and valuables at dwelling house

Consume/DRINK : Endeavor to increase your fluid intake (such as water and juice) for the 2 days leading upwards to your procedure unless a medical condition does not allow you to safely do and so. If you lot are not sure if it is safe for yous, contact your primary care provider or referring provider.

Still, on the 24-hour interval of the procedure, do not swallow for three hours before the procedure. You may have liquids and tin have your usual medications unless previously advised to agree sure medications in preparation for the lumbar puncture.

MEDICATION : All patients tin can take their prescribed medications as usual unless instructed to hold certain medications such as blood thinners. Please bring a current list of your medications and allergies with you.

TRAVEL : You must take an adult driver accompany you and so they tin can drive you domicile after the process. This is for your condom and comfort.

  • Go far 1 60 minutes prior to the scheduled procedure time for check-in and to be prepped for the procedure.
  • Delight note: You will be unable to drive for 24 hours afterwards the procedure. If you are taking a cab or using public transportation, you lot demand to bring a friend or family unit member to back-trail y'all afterwards the procedure to your home or hotel. A cab or public transportation driver is not considered an escort.
illustration of lumbar puncture

What happens during a lumbar puncture?

A lumbar puncture procedure may exist done on an outpatient basis or equally function of your stay in a hospital. Procedures may vary depending on your status and your doctor's practices. Some healthcare providers may adopt to exercise this procedure at the bedside or may opt to take it done using a type of alive X-ray called fluoroscopic guidance.

Generally, a lumbar puncture follows this procedure

  • You volition remove any wear, jewelry, or other objects that may interfere with the procedure
  • You will exist given a gown to wearable.
  • You will be reminded to empty your float prior to the start of the procedure.
  • During the lumbar puncture you may lie on the exam table on your side with your chin tucked to your breast and knees tucked to your abdomen. Or, you may sit on the edge of an exam tabular array with your arms draped over a table positioned in forepart of you lot. In either position the back is biconvex, which helps to widen the spaces between your vertebrae.
  • Therefore, your back will be cleansed with an clarified solution and draped with sterile towels. The healthcare provider will article of clothing sterile gloves during the procedure.
  • The provider will numb the peel by injecting a local anesthetic. This injection may sting for a few seconds, but makes the lumbar puncture less painful.
  • The hollow needle will be inserted through the numbed peel and into the space where the CSF is located. You lot will feel some pressure while the needle is inserted. You must remain admittedly still during the insertion of the needle.
  • The CSF volition begin to drip out of the needle and a pocket-size amount, about one tablespoon, will be collected into examination tubes.
  • If the provider needs to inject medicine into the spinal canal, information technology will be given through the same needle subsequently the CSF is nerveless.
  • When the procedure is done, the needle will be removed and a bandage will be placed over the injection site. The test tubes will be taken to the lab for testing
  • Tell the healthcare provider if you lot feel whatever numbness, tingling, headache, or light-headedness during the procedure.

You may have discomfort during a lumbar puncture. Your healthcare providers volition use all possible comfort measures and complete the process as quickly equally possible to minimize any discomfort or hurting.

What happens after a lumbar puncture?

This helps reduce the incidence of a headache. You will exist allowed to scroll from side to side every bit long as your head is not elevated. If you need to urinate, you may demand to do so in a bedpan or urinal during the time that you lot need to stay flat.

You lot will be asked to drinkable actress fluids to rehydrate after the procedure. This replaces the CSF that was withdrawn during the spinal tap and reduces the take chances of developing a headache.

After recovery, you may be taken to your hospital room or discharged to your home. If you go dwelling house, usually your healthcare provider will advise you to rest for the rest of the day

In one case you are at home, notify your provider of any abnormalities, such equally:

  • Numbness and tingling of the legs
  • Drainage of blood or pain at the injection site
  • Inability to urinate
  • Headaches

If the headaches persist for more than than a few hours afterward the procedure, or when you alter positions, contact the neuroradiology team with the telephone number provided on your belch instructions.

You may be instructed to limit your action for 24 hours following the procedure.

Your healthcare provider may give you other specific instructions about what you should do after a lumbar puncture.