Talk:Lumbar puncture

I think its worth noting in the procedure section that the lumbar puncture must also penetrate the arachnoid. - JRS —Preceding unsigned comment added by 155.58.11.16 (talk) 21:29, 12 June 2008 (UTC)

Question

How long do the headaches last after a spinal tap has been done?

Hours to days, depending on the speed by which the CSF was drained. Some people keep on "seeping" CSF into their epidural space; they sometimes require a "blood patch" to stop this; the headaches resolve almost instantly. JFW | T@lk 07:41, 7 Feb 2005 (UTC)

Complication of LP

The article says, 'Some authorities believe that withdrawal of fluid when initial pressures are too low could result in spinal cord compression or cerebral herniation...' Cerebral herniation is accepted in standard texts as a well known complication of raised intracranial pressure which may occur with space occupying lesions in the brain. If what the article claims is well researched, it should be presented as an adjunct to this fact which surprisingly doesn't find a mention.

{{sofixit}}. JFW | T@lk 13:49, 28 December 2005 (UTC)

I'm the author of the text you quoted. I can't tell whether your criticism is because you think it's obvious that LP can cause cerebral herniation, or because you think it's obvious that LP could never cause cerebral herniation and that it must always be due to the presence of space-occupying lesions in the brain and never due to LP. -Ikkyu2 02:58, 30 December 2005 (UTC)

Oh, I see what your deal is. It's not whether the LP is causative, but the phrase "initial pressures too low." The idea is that in obstructive hydrocephalus the spinal pressure is significantly lower than the above-obstruction pressures, and that lowering it further can worsen the pressure gradient and cause herniation. Not everyone believes this, and even the 'too low' measured pressure is usually higher than normal in this model. I will modify the statement to weasel around this and please everyone, regardless of their interpretation of the Monroe-Kellie doctrine. -Ikkyu2 03:02, 30 December 2005 (UTC)

Why is it that this article is completely devoid of any acknowledgment of the risks of shift? That is to say, the dangers of someone having a suspected space-occupying lesion in the brain prior to the tap, which can then cause the brain to "shift" into the growth causing fatal complications. - April 4 2006

The article is still devoid of this. Some studies say that neuroimaging is only required if there is a suspected mass lesion, while other recommend it in focal signs, decreased level of consciousness or signs of raised ICP (papilloedema, decerebrate positioning etc.) I personally have never seen any junior doctor in the UK do an LP without a CT scan, probably because they are easy to obtain in patients whose history is bad enough to warrant an LP. JFW | T@lk 13:14, 21 January 2008 (UTC)

Trivia?

Since one can never be sure of the reasons that a reader might be searching for this article, I wonder if it might be worthwhile to include a mention of the urban myth that spinal taps are "routinely" performed to determine if someone has used LSD. Perhaps a brief mention in a newly added "Trivia" section would be in order. - Ugliness Man 11:24, 23 February 2006 (UTC)

Sources please for the urban myth? JFW | T@lk 13:14, 21 January 2008 (UTC)

Most painful thing ever

I heard someone on the radio say that a lumbar puncture is the most painful thing in the world ever... exactly how painful is it? --124.180.103.210 09:55, 25 June 2007 (UTC)

Child birth? —Preceding unsigned comment added by 71.86.54.3 (talk) 05:44, 29 March 2008 (UTC)

I'm pretty sure if you had a lumbar puncture done you would be sufficiently numbed up so that you couldn't feel it, otherwise you could jerk and be paralyzed.

I've been told that no anesthetics can be used, as they will distort the composition of the fluid. I sincerely hope that I will never have to undergo such a thing, though. --74.132.11.37 23:01, 7 August 2007 (UTC)

See comment below. It is probably nonsense. No it is not.JFW | T@lk 13:14, 21 January 2008 (UTC)

--I have had a lumbar puncture when it was suspected I contracted meningitis. It was forbidden to administer any anesthetic/numbing medications as that will contaminate the sample and/or mask symptoms. Also... if you're sick enough, and of the type, to need a lumbar puncture, giving you drugs that affect your nervous system is probably a bad idea.

How painful was it? Yes, I can safely say it was the most physically painful thing I've ever experienced. Even though I was only 13, I needed several nurses/orderlies to pin me down when they drew it.

So here's how I (poorly) describe the pain of the experience: You ever wonder if there is a centre to your body, like a core or a column that runs right down the middle? I don't mean the spinal column, I mean more like a metaphysical, hard to describe, centre of your being. Now also think of all the nerves in your body, from deep inside you to the very extremes of your body - your fingertips, the soles of your feet, your scalp.

When the lumbar needle (which feels as thick as coat-hanger wire, btw) gets tapped in, it's like someone pounding a nail into the wall to hang a picture. Except that wall is your soul. Every nerve, every cell, every ounce of your being rings and trembles like it's been hit by a sledgehammer... it's electrifying. In an instant you can feel the whole totality and mass of your body. It's not like being hit in a fight, struck by a car, or falling. This pain comes from deep inside you and radiates outwards.

Once it's in and they're drawing the CSF, it ain't so bad. I couldn't tell you about the headaches afterwards, since it wasn't too long after that I started convulsing and hallucinating.

It sounds awful. But how certain are you that no local anaesthetic was used? Lidocaine, when injected under the skin, gives a pretty nasty burning sensation that precedes the numbness. JFW | T@lk 13:14, 21 January 2008 (UTC)

Agree with the depiction of the pain. It should probably be mentioned on the article. As they told me, the could use anesthetic but that only works for the skin and muscle part of the pain, which is just as any injection. The pain that comes when they touch and penetrate the dura mater and arachnoid mater inside the spine. —Preceding unsigned comment added by 144.171.157.73 (talk) 21:45, 23 November 2010 (UTC)

Local anesthesia for LP and the "give" entering the dura mater

1) Local anesthesia with lidocaine is standard procedure for an LP. It should never be performed without this, and lidocaine is included in all lumbar puncture kits that I have seen. I wonder what year the incident occurred in which the man writing below (above, comment was moved JFW | T@lk) had an LP without anesthesia - if it wasn't a very long time ago then he has grounds for a lawsuit. 2) I believe that the "give" which the author refers to in the procedure section is the needle puncturing the ligamentum flavum just before entering the dura mater. —Preceding unsigned comment added by 128.252.16.235 (talk) 14:20, 26 September 2007 (UTC)

Thanks. I agree that LP without analgesia is not of this day and age. Mind you, the lidocaine does not actually mix with the CSF. All it does is dull the nerve endings of the skin and subcutaneous tissues.

Everyone always says that the "give" is the penetration of the dura. Having done my own bunch of LPs I can definitely identify with its description. JFW | T@lk 13:14, 21 January 2008 (UTC)

I have stuck a lot of needles through the ligamentum flavum and the dura and I concur with JFW. The ligamentum flavum is resilient and it grips the needle (most noticeable with a Tuohy needle, which is relatively blunt and bigger, at 16g or 18g, than anything you should use for an LP). There is no 'pop' or 'give' when you go through to the other side of the LF because the needle is still gripped by the ligament; instead, penetration of the LF is detected by sudden loss of resistance to injection. Using a pencil point needle for an LP (and I submit that only the ignorant or cruel would use anything else these days) there is usually a noticeable 'pop' as the tip passes through the dura-arachnoid, which is most helpful. I do not think people who use cutting needles get this sign.Moletrouser (talk) 13:06, 12 March 2017 (UTC)

..

Platelets

doi:10.1111/j.1365-2141.2009.07899.x review of safety of LPs in people with low platelets. JFW | T@lk 18:29, 15 December 2009 (UTC)

doi:10.1002/14651858.CD012497.pub2 - Cochrane, no good data on use of plasma in those with abnormal coagulation studies. JFW | T@lk 19:56, 28 January 2018 (UTC)

Can IV sedation be used when a doctor does a lumbar puncture?

The doctor tried doing a lumbar puncture without success. The local medication used did not numb the area and when the puncture needle was being inserted, I felt lots of pressure and pain. I have very sensitive nerves due to polyneuropathy. The doctor tried two or three times and just gave up as I was moving around too much and he couldn't take the chance of doing it. My Neurologist is trying to rule out CIDP and other muscular diseases. I was wondering if this procedure can be done using IV sedation? An answer would be very appreciated.

70.173.117.53 (talk) 11:12, 2 April 2010 (UTC)

I'm sure this is done occasionally, but you should discuss this with your neurologist in the first instance. JFW | T@lk 10:46, 2 March 2014 (UTC)

Pictures

I love reading about medical things but actual pictures of it make me go berserk. Is there any way to like turn of medical pictures or things like this? An option or anything? 71.161.201.163 (talk) 14:17, 24 February 2011 (UTC)

Your browser should have a setting for that. Wikipedia is not censored, so I'm afraid you can't get us to do it for you. JFW | T@lk 10:46, 2 March 2014 (UTC)

Who does it?

Is this procedure typically done by a neurologist or surgeon, or is it also done in primary-care practice? Or, do physician assistants and advanced-practice registered nurses (nurse-anesthetists or nurse-practitioners) also do it? 74.96.75.216 (talk) 04:21, 11 January 2014 (UTC)

Difficult to answer without a source. In the UK it is done almost invariably by doctors. JFW | T@lk 10:46, 2 March 2014 (UTC)

Updating

The article needs work, but things could be worse. Per WP:MEDMOS, we should be grouping "contraindications" under "indications" and we should discuss the principles of the procedure under a section called "Mechanism" before describing the actual procedure in "Procedure". The analysis and interpretation comes under a further section called "Interpretation", followed by "Adverse effects" and finally "history". I will make these changes.

1. Indications - build this on 1-2 sources (journal and/or textbook)
2. Mechanism - expand using Wright and at least 1-2 other sources
3. Procedure - make prose a little less dense, add information about fluoroscopy and ultrasound as adjuncts in difficult procedures
4. Interpretation - rearrange using less bullet points, perhaps converge towards less sources
5. Adverse effects - Wright reviews this in detail
6. History - some expansion needed

Sources:

• I am keen to drop Sempere and Gröschel as sources considering they're not in English and there are other English papers available
• All sources that don't comply with WP:MEDRS should be dropped
• We could get more information from Straus and Roos
• Wright doi:10.1007/s00415-012-6413-x is a strong source that can help
• PMID 22111091 (Cooper 2011) has some stuff that might complement the other sources

No timeframe is intended, but the above are my intentions. JFW | T@lk 12:17, 14 March 2014 (UTC)

Why do "rachicentesis" and "rachiocentesis" redirect here?

Not mentioned in article. 109.157.79.50 (talk) 04:33, 9 January 2015 (UTC)

Peer Review

Just a few comments and suggestions for this article, broken down by section:

The Lead: I like how concise the lead is. You may want to add a definition of "Cerebellar tonsils herniation" to something more easily readable to general population, such as "compression of brain tissue". Potential to place citations throughout the lead, as there are currently no citations present in the lead.

Medical uses and Indications: Might want to add in "therapeutic" section of doing LP's pseudo-tumor cerebri.

Contraindications: May want to clarify if something is an absolute vs relative contraindication.

Adverse effects: The content of this section is good. I would try to cut down on the sentence length, as some of them are quite long.

Citations would be helpful in the 3rd paragraph of Adverse effects (the paragraph beginning with "The procedure us not recommended when…"

Technique: I really like the pictures on the side depicting patient positions and the needle piercing the appropriate layers. Citations would be helpful for certain paragraphs within this section, including the 2nd paragraph "The upright seated position…" and 3rd paragraph "Patent anxiety during…" within the procedures section.

For the special consideration for pediatric patients, you can leave out the "One study with 132 patients compared…" part and just treat it as a statement. No need to add in methodology to a specific study.

Interpretation: Good organization, I like the included table with citations.

Overall, very good improvements to the article!

- — Preceding unsigned comment added by Glam316 (talk • contribs) 20:58, 14 November 2015 (UTC)

Opening Pressure?

The pressure of the CSF at lumbar puncture is often referred to as opening pressure but I have not seen, in Wikipedia or elsewhere, any explanation of the meaning intended by the word opening in this context. The article uses the expression three times, but the rest of the time refers only to pressure or CSF pressure; the article on CSF does not use the expression. Does anyone know what opening pressure conveys that pressure does not? Moletrouser (talk) 13:19, 12 March 2017 (UTC)

@Moletrouser: The precise etymology of "opening pressure" isn't clear to me, but if CSF is removed then the pressure recorded at the end of the procedure is called the "closing pressure". I therefore presume that it is the pressure at the "opening" of an LP session. If I come across anything else I will add it. JFW | T@lk 15:36, 14 February 2018 (UTC)

Lancet Neurology

doi:10.1016/S1474-4422(18)30033-4 review by the Dutch meningitis people. JFW | T@lk 15:36, 14 February 2018 (UTC)

Wiki Education assignment: Wikipedia for the Medical Editor

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 October 2023 and 18 November 2023. Further details are available on the course page. Student editor(s): Apetko3 (article contribs).

— Assignment last updated by Apetko3 (talk) 09:04, 9 November 2023 (UTC)