Info

🌱 來自: Huppert’s Notes

Lumbar Puncture

•   Common indications: Concern for CNS infection, autoimmune or inflammatory condition, or malignancy; also can be used to diagnose subarachnoid hemorrhage, intracranial pressure abnormalities, or to reduce CSF pressure therapeutically

•   Obtain NCHCT prior to LP if: Patient >60 yr, immunocompromised state, history of CNS disease (e.g., mass lesion, stroke, focal infection), seizure within one week of presentation, focal neurologic deficit

•   CSF studies: -   Always send: Cell count with differential, protein, glucose (check serum glucose simultaneously) -   Additional CSF testing to consider based on clinical suspicion: •   Autoimmune or inflammatory: Oligoclonal bands, IgG index, targeted autoantibody tests •   Infection: Bacterial gram stain and culture, targeted infectious studies (PCR, serology, AFB, fungal, or viral culture) •   Malignancy: Cytology and flow cytometry •   Contraindications: -   Local infection over the site of puncture -   Coagulopathy: Platelet goal >50K/μL, INR < 1.7 -   If known intracranial or spinal cord mass lesion, always obtain imaging first. Mass lesions are not always a contraindication for LP, but imaging should be reviewed prior to attempted LP