Are some of the contraindications for lumbar punction outdated today? A Case Report

Czech version

Authors: M. Kala ¹; M. Vaverka ²; M. Kolář ¹
Authors‘ workplace: Neurochirurgická klinika LF UP a FN Olomouc ¹; Ústav mikrobiologie LF UP a FN Olomouc ²
Published in: Cesk Slov Neurol N 2007; 70/103(5): 570-573
Category: Case Report

Overview

In the era of imaging methods, lumbar punction retains its significance as a diagnostic procedure. Its contraindication is intercranial hypertension together with symptoms of focal neurological disorder of the brain. Examination of the intracranial anatomic situation with the use of magnetic resonance imaging allows for detailed analysis of the status of subarachnoid spaces and, primarily, the cisterns at the base of the brain, thus largely suppressing the risk associated with lumbar punction in some patients or, in the opposite case, alerting for a higher risk associated with the procedure in other patients (e.g. in the case of Chiari malformation). In case of existence of a higher risk associated with lumbar punction, we recommend to perform the procedure with the patient lying on his or her flank and always under the control of an anaesthesiologist, at an intensive care unit where the patient will be observed after the procedure.

Key words:
lumbar punction –⁠ contraindications –⁠ intracranial hypertension –⁠ rombencephalitis –⁠ Chiari malformation

Sources

1. Eck H. Encephalomyelitis listeriaca apostematosa. Schweiz Med Wochenschr 1957; 87 : 210-214.

2. Hansen PB, Jensen TH, Lykkegaard S, Kristensen HS. Listeria monocytogenes meningitis in adults. Sixteen consecutive cases 1973-1982. Scand J Infect Dis 1987; 19 : 55-60.

3. Uldry PA, Kuntzer T, Bogousslavsky J, Regli F, Miklossy J, Bille J et al. Early symptoms and outcome of Listeria monocytogenes rhomboencefalitis: 14 adult cases. J Neurol 1993; 240 : 235-242.

4. Brun-Buisson CJ, de Gialluly E. Fatal nonmeningitic listeria rhombencephalitis. Report of two cases. Arch Intern Med 1985; 145 : 1982-1985.

5. Illanes SD, Araya PC, Ferrer SD, Cartier LR, Bravo MM, Castillo SC. Rhomboencephalitis caused by listeria monocytogenes infection. Report of three cases. Rev Méd Chile 2003; 131 : 921-928.

6. Pericot I, Río J, Rovira A, Montalbán X, Codina A. Rombencefalitis por listeria. Hallazgos neurorradiológicos. Neurología 2003; 18 : 34-37.

7. Rickmann H, Obhof W, Rauh J, Druschky K-F. Rhombenzephalitis durch Listeria monocytogenes. Nervenarzt 1994; 65 : 557-559.

8. Beneš V, Netuka D, Kramář F, Charvát J. Současný stav péče o intrakraniální aneuryzmata. Čes Slov Neurol N 2006; 69/102 : 160-174.

9. Rastogi S, Liebeskind DS, Zager EL, Volpe NJ, Weigele JB, Hurst RW. Rapid cognitive decline following lumbar puncture in a patient with a dural arteriovenous fistula. Surg Neurol 2004; 62 : 341-345.

10. Gorelick PB, Biller J. Lumbar puncture. Technique, indications, and complications. Postgrad Med 1986; 79 : 257-268.

11. Sullivan HC. Fatal tonsillar herniation in pseudotumor cerebri. Neurology 1991; 41 : 1142-1144.

12. Banik R, Lin D, Miller NR. Prevalence of Chiari I malformation and cerebellar ectopia in patients with pseudotumor cerebri. J Neurol Sci 2006; 247 : 71-75.

13. Baldwin HZ, Rekate HL. Preliminary experience with controlled external lumbar drainage in diffuse pediatric head injury. Pediatr Neurosurg 1991-92; 17 : 115-120.

14. Abadal-Centellas JM, Llompart-Pou JA, Homar-Ramirez J, Perez-Barcena J, Rossello-Ferrer A, Ibanez-Juve J. Neurologic outcome of posttraumatic refractory intracranial hypertension treated with external lumbar drainage. J Trauma 2007; 62 : 282-286.