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Lumbar Puncture E.Fakharian, M.D Assistant Professor of Neurosurgery Kashan University of Medical Sciences

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Presentation on theme: "Lumbar Puncture E.Fakharian, M.D Assistant Professor of Neurosurgery Kashan University of Medical Sciences"— Presentation transcript:

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2 Lumbar Puncture E.Fakharian, M.D Assistant Professor of Neurosurgery Kashan University of Medical Sciences

3 Lumbar Puncture LP is an invasive procedure for obtaining CSF. LP is an invasive procedure for obtaining CSF. First reports of CSF is in Edwin-Smith Surgical Papyrus written 3700 yrs ago. First reports of CSF is in Edwin-Smith Surgical Papyrus written 3700 yrs ago. Hippocrates reported CSF presence in brain cavities, 4 centuries B.C. Hippocrates reported CSF presence in brain cavities, 4 centuries B.C. Galen described ventricular cavities 2 centuries A.C. Galen described ventricular cavities 2 centuries A.C. In 1891 Heinrich Quincke, of Kiel, Germany, introduced this procedure as we know it today. His original intent was to help babies suffering from hydrocephalus by draining away excess fluid, but from the outset he was also interested in lumbar puncture's use as a diagnostic tool, & examined CSF for its pressure, sugar, protein, & cell count. In 1891 Heinrich Quincke, of Kiel, Germany, introduced this procedure as we know it today. His original intent was to help babies suffering from hydrocephalus by draining away excess fluid, but from the outset he was also interested in lumbar puncture's use as a diagnostic tool, & examined CSF for its pressure, sugar, protein, & cell count. Widal introduced CSF cytological studies in Widal introduced CSF cytological studies in 1901.

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5 LP for Dx Infections, e.g. meningitis. Infections, e.g. meningitis. Demyelinating diseases, e.g., M.S. Demyelinating diseases, e.g., M.S. High ICP, e.g., pseudotumor cerebri. High ICP, e.g., pseudotumor cerebri. Bleeding, e.g., SAH. Bleeding, e.g., SAH. Introducing contrast agent for Dx, e.g., DH,…. Introducing contrast agent for Dx, e.g., DH,…. LP for RX Infections, e.g. meningitis. Infections, e.g. meningitis. High ICP, e.g., pseudotumor cerebri. High ICP, e.g., pseudotumor cerebri. Malignancies, e.g., leukemia. Malignancies, e.g., leukemia. Anesthesia Anesthesia Others, e.g., CSF leakage. Others, e.g., CSF leakage.

6 Lumbar Puncture Complications Low pressure H/A. Low pressure H/A. Hematoma. Hematoma. Cerebral herniation. Cerebral herniation. Infections. Infections. Neural injury. Neural injury. LBP. LBP.Contraindications Infection or wound at the site of LP Infection or wound at the site of LP Bleeding tendency. Bleeding tendency. Intracranial or intraspinal mass lesions. Intracranial or intraspinal mass lesions.

7 Lumbar Puncture Procedure: Sitting Sitting Lying down Lying down L2/L3 level downwards L2/L3 level downwards Needle between 2 spinal processes Needle between 2 spinal processes 30* cephalad direction 30* cephalad direction Beveled tip direction depends to the aim of LP Beveled tip direction depends to the aim of LP

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10 Quinke needlesSprotte needleTouhy needle

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