• Lumbar Puncture

    (Cerebrospinal Fluid Analysis; Cerebrospinal Fluid Tap; Spinal Tap)

    Definition

    Lumbar puncture is a test of the fluid around your spine and brain. This fluid is called cerebrospinal fluid (CSF). It provides protection and nutrition to the brain and nerve cells. CSF also helps to remove waste products from the brain. A lumbar puncture is done with a needle.
    Lumbar Puncture Method
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    Reasons for Procedure

    The test is done to look for abnormalities in the spinal fluid. It may be done to help diagnose conditions such as:
    • Brain infection, or infection of the layers around the brain
    • Multiple sclerosis (MS)
    • Any disorder affecting the nervous system
    • Certain types of cancer
    • Bleeding in the brain or spinal cord
    • Excess CSF in the brain
    The procedure may also be done to:
    • Administer dye for imaging studies
    • Drain CSF to lower pressure within the brain
    • Give medicine directly to the spine (such as, chemotherapy, antibiotics, anesthesia)

    Possible Complications

    If you are planning to have a lumbar puncture, your doctor will review a list of possible complications. Complications may include:
    • Headache
    • Backache
    • Bleeding (which can compress the nerve roots or spinal cord)
    • Pain or abnormal burning, pricking, or tingling sensations in legs
    • Allergic reaction to anesthetic
    • Infection

    What to Expect

    Prior to Procedure

    Your doctor may order a CT scan of the head before the procedure. A CT scan makes detailed pictures of your brain.
    Just before the surgery your doctor will clean the site where the needle will be inserted.

    Anesthesia

    Local anesthesia will be used most often. It numbs just a small area. The medicine is injected with a needle.

    Description of Procedure

    You will lie on your side with your knees drawn up in front. (Some punctures may be done while you sit on the edge of the bed.) A needle will be inserted into the spinal canal through the lower back. The doctor will take a sample of CSF through the needle.
    During the procedure, your doctor will make a note of the pressure of the CSF. If you have discomfort, the needle may need to be repositioned. It may take several minutes for the doctor to collect all the fluid he needs. Once the doctor is done, the needle will be taken out. A dressing will be placed over the puncture.

    Immediately After Procedure

    You will lie down for 10-15 minutes. Unless you have a severe headache, you will be able to go home.

    How Long Will It Take?

    About 30-45 minutes from setup to completion

    Will It Hurt?

    Discomfort is minimal to moderate. The anesthetic will sting when first injected.

    Post-procedure Care

    When you return home after the procedure, do the following to help ensure a smooth recovery:
    • Drink extra fluids for the next 24 hours.
    • Rest and remain quiet for at least 24 hours.
    • Be sure to follow your doctor's instructions.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Severe headache or headache lasting for more than 24 hours
    • Nausea or vomiting
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, bleeding, or discharge from the lumbar puncture site
    • Numbness, tingling, or pain in your lower back or legs
    • Weakness in your lower legs or difficulty walking
    • Problems with urination or defecation
    • A stiff neck
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, or chest pain
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Family Physicians http://www.aafp.org

    United States National Library of Medicine http://www.nlm.nih.gov

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Adams RD, Victor M, et al. Disturbances of cerebrospinal fluid and its circulation, including hydrocephalus and meningeal reactions. In: Adams RD, Victor M, Ropper AH. Pinciples of neurology. San Francisco: McGraw-Hill; 1997:623-641.

    Lumbar puncture (LP). DynaMed website. Available at https://dynamed.ebscohost.com/about/about-us. Updated May 31, 2012. Accessed August 31, 2012.

    Lumbar puncture. Journal of American Medical Association website. Available at: http://jama.jamanetwork.com/article.aspx?articleid=203803. Updated July 2008. Accessed August 31, 2012.

    Lumbar puncture test. The University of Iowa website. Available at: http://www.uihealthcare.com/topics/brainnervoussystem/lumbarpuncturetest.html. Published 2005. Accessed August 31, 2012.

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