Lumbar Puncture
Lumbar puncture can be important for treatment if the clinical diagnosis is
in doubt particularly, in children who are febrile without a focus. For children
with obvious meningeal symptoms, microbiological confirmation is valuable for
- duration of treatment
- decisions about prophylaxis and public health management,
- follow up care of children who recover with neurological sequelae, and
- disease surveillance.
However, LP must not be performed when there are contraindications and should
never delay treatment. With modern PCR techniques, CSF samples may still be
positive after antibiotics have killed the organisms.
Check with a senior colleague if you are unsure.
Before attempting lumbar puncture assess HR, RR, BP, CRT, pupils, rash, fundal examination for papilloedema.
Make sure there are no signs of raised intracranial pressure or shock.
- Prolonged or focal seizure
- Focal neurological signs ( including ocular palsies)
- Widespread purpuric rash in ill child
- Glasgow coma score <13
- Pupillary dilatation
- Impaired oculocephalic reflexes
- Abnormal posture
- RICP: inappropriately low pulse, elevated blood pressure and irregular respirations. (indicating impending brain herniation)
- Coagulopathy
- Papilloedema
- Hypertension
Lumbar puncture should also be avoided where there is any cardiovascular or respiratory compromise or if there is local infection at the site of LP.