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Diagnostic
CNS infections like meningitis, encephalitis, subarachnoid hemorrhage, pseudotumor cerebri, inflammatory CNS diseases like Guillain – Barre syndrome.
- nstillation of intrathecal dye for imaging procedures (e.g. myelography)
- Measurement of CSF pressure.
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Therapeutic
Instillation of intrathecal medications (e.g. chemotherapeutic CNS prophylaxis in leukemia, tetanus immunoglobulin in tetanus.
- Spinal anesthesia
- Written informed consent.
- Position: lateral position with flexed knee/ hip joint / sitting position in elder children Preparation of the parts: Site - L2 – L3 / L3- L4
During the procedure
- Give local anesthesia
- A L.P. needle is inserted in vertebral space
- Through the spinal membrane (dura) and to reach the subarachnoid space.
- CSF is collected in sterile containers.
- The needle is removed, and the puncture site is covered with a bandage.
- Elevated Intracranial pressure owing to a suspected mass lesion of the brain or spinal cord. (So fundus examination & head CT are mandatory)
- Severe respiratory distress & shock etc. as that may worsen with positioning in flexion.
- Thrombocytopenia. (˂ 20,000 cells/mm3)
- Local infection at the site
- Post LP headache and backache
- Latrogenic meningitis
- Cerebral herniation in sudden drop of elevated intracranial pressure.
