Lumbar puncture (spinal tap)

A lumbar puncture (spinal tap) as the name indicate is performed in the lumbar region.

During a lumbar puncture, a needle is inserted between two lumbar bones (usually between vertebrae L3-L4 ; L4-L5) to remove a sample of cerebrospinal fluid. This is the fluid that surrounds your brain and spinal cord to protect them from injury.

A lumbar puncture can help diagnose serious infections, such as meningitis; other disorders of the central nervous system, such as Guillain-Barre syndrome and multiple sclerosis; or cancers of the brain or spinal cord.

A lumbar puncture may be done to:

.Collect cerebrospinal fluid for laboratory analysis

.Measure the pressure of your cerebrospinal fluid

.Inject spinal anesthetics, chemotherapy drugs or other medications

.Inject dye (myelography) or radioactive substances (cisternography) into cerebrospinal fluid to make diagnostic images of the fluid's flow.

A man with parenchymal bleeding, biparietal displaced fracture and Coronal-Sagittal sutures diastases

 A 61-year-old man presented with sudden onset of excessive agitation. While walking home late in the evening, he lost his balance, fell and hit his head on the ground. He had a history of diabetes melitus, hypercholesterolemia, hypertension and coronary artery disease with a pacemaker placed a year ago. 2 years ago he had an episode of transient ischemic attack which led to a right sided hemiparesis. He was taking metformin for his diabetes melitus; metoprolol, spironolactone, ramipril for his hypertension; atorvastatin for his hypercholesterolemia; aspirin and coumadin for anticoagulation. His vitals on presentation were temperature 36,4, blood pressure 150/90, respiratory rate 18/min, pulse 78/min.CT scan on admission (see above: LEFT: brain window RIGHT: bone window) showed parenchymal bleeding, biparietal displaced fracture and Coronal-Sagittal sutures diastases.

He was considered a high-risk candidate for emergent surgery by the anesthesia team and send to the ICU for follow-up. The neurosurgery team declared the patient inoperable due to the high risk of mortality intra-operatively. He died a couple of weeks later as his health deteriorated.