Lumbar puncture and CSF examination. Answers to three commonly asked questions

The incidence of post-lumbar puncture headache has been shown to be reduced by using a higher-gauge (smaller-bore) needle and orienting the needle bevel parallel to the dural fibers. Incidence of headache is the same in patients given bed rest as in patients who are mobilized immediately. Cerebrospinal fluid (CSF) examination of patients with seizures of unclear cause is indicated. However, pleocytosis can be a result of the seizure alone. Other causes of pleocytosis must be ruled out by clinical evaluation and CSF studies. Although lumbar puncture is often advocated for patients presenting with dementia, it usually is not helpful in finding a specific cause if the dementia is long-standing.