Wednesday, January 26, 2011

Contraindications to lumbar puncture

A lumbar puncture should not be performed in a patient with suspected meningococcemia when certain conditions are present. This is intended to minimize the risk for cerebral herniation or other adverse effect when there may be little additional information obtained from the CSF studies.

Contraindications to lumbar puncture:

(1) confident clinical diagnosis of meningococcal disease, with typical hemorrhagic rash

(2) drowsiness or impaired consciousness

Glasgow coma scale <>

  deteriorating Glasgow coma scores

  signs of raised intracranial pressure

(3) focal neurologic signs

(4) signs of raised intracranial pressure, including marked instability in blood pressure and heart rate

(5) evidence of septic shock, with signs of poor perfusion

(6) infection at the planned lumbar puncture site

(7) moderate to severe bleeding disorder

Additional notes:

(1) A normal CT scan does not exclude a raised intracranial pressure.

(2) If lumbar puncture is not performed and the patient has not improved within 24 hours despite therapy, then reassess the need for lumbar puncture.

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