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Contraindications to lumbar puncture as defined by computed cranial tomography
D J Gower1, A L Baker, W O Bell
1Department of Surgery, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27103.
Journal of Neurology, Neurosurgery, and Psychiatry
|August 1, 1987
Summary
Papilloedema is not always a reliable indicator for lumbar puncture complications. Computed tomography (CT) scans can identify specific anatomical signs predicting herniation risk, guiding safer lumbar puncture procedures.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Lumbar puncture (LP) is a common diagnostic procedure.
- Papilledema is an unreliable indicator for potential complications during LP.
- Computed tomography (CT) is increasingly used to assess patients before LP.
Observation:
- Clinicians use CT scans to identify patients at risk of herniation during LP.
- Specific CT-defined anatomical criteria correlate with intracranial pressure shifts.
- These criteria indicate a predisposition to herniation upon spinal decompression.
Findings:
- CT findings such as midline shift, effaced basal and suprachiasmatic cisterns, and obliterated ventricles or cisterns are associated with herniation risk.
- Obliteration of the superior cerebellar and quadrigeminal plate cisterns with ambient cistern sparing is a key indicator.
- These radiological signs suggest contraindications for performing lumbar puncture.
Implications:
- CT-based anatomical criteria can improve patient selection for lumbar puncture.
- Identifying these contraindications can prevent serious complications like brain herniation.
- This approach enhances the safety of lumbar puncture procedures in at-risk patients.