1. Introduction to Clinical Skills: Lumbar Puncture
Gregory Gruener, M.D.
Department of Neurology

2. Considerations Why is an LP Being Done?
Is this the Only Test Available?
What Positive Information is Expected?
Is the Patient Stable?

3. Indications Diagnostic Therapeutic Incidental Infection
Subarachnoid Hemorrhage
Multiple Sclerosis
Therapeutic
Neoplasm
Incidental
Myelography

4. Contraindications Suspected Increase in ICP
Suspected Spinal Cord Compression
Infection at the Site of an LP
Coagulopathy

5. Normal CSF Values Appears to be clear and colorless
Opening Pressure ~ 120 mm/H20
Protein level ~ 35 mg%
Glucose level ~ 60 mg %
(60% of serum glucose)
Cells < 5 lymphocytic/monocytic

6. CSF Profile’s

7. Proper Positioning (one)

8. Proper Positioning (two)

9. Preparation for the LP (one)

10. Preparation for the LP (two)

11. Injection of the skin

12. Proper Positioning (one)

13. Proper Positioning (two)

14. Incorrect Position (one)

15. Incorrect Position (two)

17. Alternative Techniques
Sitting Position
Radiological Guidance
Cisternal Tap
Cervical Tap
Lumbar Puncture Technique in Neonates and Infants

18. Complications Headache (Post LP Headache) Painful Paresthesias
Persistent Pain or Paresthesias
Spinal Hematoma
Spinal Infection
Herniation

19. CSF Leak (one)

20. CSF Leak (two)

21. Complications Headache Painful Paresthesias
Persistent Pain or Paresthesias
Spinal Hematoma
Spinal Infection
Herniation

22. Complications Headache Painful Paresthesias
Persistent Pain or Paresthesias
Spinal Hematoma or a Bloody Tap
Spinal Infection
Herniation

23. “Bloody Tap”

24. Complications Headache Painful Paresthesias
Persistent Pain or Paresthesias
Spinal Hematoma
Spinal Infection
Herniation

25. Complications Headache Painful Paresthesias
Persistent Pain or Paresthesias
Spinal Hematoma
Spinal Infection
Herniation (Brain not the disc)