Lumbar Puncture (Lumbar Puncture)

A lumbar puncture is used to: Evaluate intracranial pressure and CSF composition (see Table: Liquoranomalien in various diseases) therapeutic reduction of intracranial pressure (eg, idiopathic intracranial hypertension.) Administering intrathecal medication or an X-ray contrast medium for myelography Spinal Tap video created by Hospital Procedures Consultants, www.hospitalprocedures.org. var model = {videoId: ‘3902008740001’, playerId ‘SyAEZ6ptl_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4412121335001_vs-55c8fc07e4b02826db661004-782203287001.jpg?pubId=3850378299001&videoId=3902008740001’ title: ‘Spinal Tap’, description: ” credits ‘video created by Hospital Procedures Consultants, www.hospitalprocedures.org’ hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Liquoranomalien in various diseases Physical Conditions Pressure * leukocytes / ul * The predominant cell type protein * Normal glucose 100-200 mm H2O 0-3 L 50-100 mg / dL (2.78 to 5.55 mmol / l) 20-45 mg / dl Acute bacterial meningitis ? 100-10000 PMN ?> 100 mg / dl † Subacute meningitis (eg. B. due to tuberculosis, Cryptococcus infection, sarcoidosis, leukemia, or carcinoma) N or ? ? ? 100-700 L Acute syphilitic meningitis N or ? ? 25-2000 L N hemiplegic neurosyphilis N or ? ? L N 15-2000 Lyme disease of the CNS or ? N 0-500 N N L ? or brain abscess or tumor, or N ? ? 0-1000 L N N viral infections or ? ? or 100-2000 L N N Idiopathic intracranial hypertension ? N L N N or ? ? cerebral hemorrhage blood erythrocyte count N ? ? or cerebral thrombosis N 0-100 N N L ? or spinal cord tumor N 0-50 L N N or ? Multiple Sclerosis N 0-50 L N N or ? Guillain-Barre syndrome N 0-100 L N> 100 mg / dl of lead encephalopathy ? 0-500 N L ? standard values ??to pressure, cell number, and protein are approximations; Exceptions are common. Likewise PMN may predominate in disorders, which are normally characterized by a lymphocyte response, v. a. early in the course of viral infection or tuberculous meningitis. Glucose values ??differ less, and are more reliable. † Up to 14% of patients may have a protein level of up to <100 mg / dl at the first lumbar puncture in the cerebrospinal fluid. L = lymphocytes; N = normal; PMN = polymorphonuclear neutrophils; = Increased ?; ? = decreased. Relative contraindications: infection at the puncture site bleeding Increased intracranial pressure due to an intracranial space occupying lesion, a Liquorabflussstörung (eg by aqueduct or Chiari I malformation.), Or spinal cord-Liquorblockade (for example, by tumor compression.) If papilledema or present focal neurological deficits, a CT or MRI should be performed before the lumbar puncture to exclude a mass that could lead to a transtentoriellen impaction or impingement of the cerebellar tonsils, (entrapment of brain tissue.). In the lumbar puncture lumbar puncture, the patient is typically located in the left lateral position. A cooperative patient is asked to put on their knees and curling up as closely as possible (to make a hump). Patients who can not maintain this position must be held by assistants. Sometimes the spine can be more bent when patients, especially obese, sitting at the edge of the bed and lean over a bedside table. An area with a diameter of 20 cm is cleaned with several times with a modern disinfectant and sterile swabs. The doctor wearing sterile gloves to protect themselves. A spinal needle with stylet (is the spinous process L4 iliac typically on a line between the two spines posterior) in the space between L3 to L4 or L4 to L5 inserted; the needle is rostral aligned with the navel of the patient and kept horizontally. The entry into the subarachnoid space is often associated with overcoming a slight resistance; the stylet is withdrawn, to drain the cerebrospinal fluid. The opening pressure is measured with a pressure gauge or tubing; for the investigation of 4 tubes are each filled with 2-10 ml of CSF in the rule. The puncture site is then covered with a sterile patch. A post-dural-puncture headache occurs in approximately 10% of patients. Lumbar puncture. In the lumbar puncture, the patient is typically in the left lateral position. A spinal needle with stylet (is the spinous process L4 iliac typically on a line between the two spines posterior) in the space between L3 and L4 to L5 inserted; the needle is rostral aligned with the navel of the patient and kept horizontally. The entry into the subarachnoid space is often associated with overcoming a slight resistance; the stylet is withdrawn, to drain the cerebrospinal fluid. CSF Color Normal CSF is clear and colorless; ? 300 cells / mm cause increased turbidity. Bloody fluid may indicate a traumatic puncture (the needle is inserted too far into the venous plexus along the front wall of the spinal canal), or a subarachnoid haemorrhage. A traumatic puncture characterized by Stepwise clearing of the liquor between the first and fourth tube (as confirmed by a reduction in red cell count) No xanthochromia (yellowish liquor due to lysed erythrocytes) remains in a centrifuged sample freshness, "uncrenated" erythrocytes In a subarachnoid hemorrhage of the CSF equal in all blood samples taken; several hours after the event a xanthochromia is often undetectable, and the erythrocytes are normally deformed older and stronger. A slightly yellowish liquid can also result from age dyes severe jaundice or increased protein content (> 100 mg / dl). CSF cell count and glucose and protein levels cell number, cell differentiation, and are Liquorglukose- -proteinspielgel in the diagnosis of many neurological diseases (see table: Liquoranomalien in various diseases) useful. The normal CSF-blood glucose ratio is about 0.6, the glucose content in the liquor is located, except in severe hypoglycemia, usually at> 50 mg / dl (> 2.78 mmol / l). Increased CSF protein (> 50 mg / dl) is a sensitive, but non-specific disease indicator; Protein increases to> 500 mg / dl may occur in purulent meningitis, tuberculous meningitis and advanced a total Liquorblockade in spinal cord tumors or blood admixtures during the spinal tap. Special tests on globulins (usually <15%), oligoclonal bands and myelin basic protein are helpful in clarifying demyelinating diseases. (Editor's note: study on myelin basic protein is rather out of date.) Clinical Calculator: Correction of CSF protein concentration in blood contamination of CSF Clinical Calculator: correction of the CSF LEUK at blood contamination of CSF CSF staining, -Investigating and culture In V. a. Infection is the centrifuged spinal fluid sediment for the detection of bacteria (Gram stain), tuberculosis (acid fast staining or immunofluorescence) and Cryptococcus sp. (Ink preparation) stained. Larger Liquorvolumina (10 ml) enhance the chances of detection of the pathogenic agent, especially acid-resistant bacteria, and certain fungi in dyeings and cultures. In an early meningococcal meningitis or severe leukopenia the CSF protein may be too low to allow the adherence of bacteria to the slide during the Gram stain and thus provide false-negative results. Mixing a drop aseptic serum for spinal fluid sediment avoids the problem. If a hemorrhagic encephalitis is suspected, a humidity chamber is used to search for amoebas. The Latexpartikelagglutination and Koagglutinationstest allow rapid identification of bacteria, especially if stains and cultures are negative (eg. As in anbehandelter meningitis). Liquorkulturen should be set aerobic and anaerobic and acid-fast bacilli and fungi. With the exception of enteroviruses viruses are rarely isolated from the cerebrospinal fluid. Viral antibody tests are available. Studies on syphilis and Kryptokokkenantigentests often run routinely. PCR tests for herpes simplex virus and other CNS-pathogenic viruses are increasingly available.

Health Life Media Team

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