Contraindications to lumbar puncture

The complications of lumbar puncture are:

• coning
• introduction of infection into the CSF

For these reasons the following signs are contraindications for lumbar puncture:

• local skin sepsis
• bleeding diatheses, e.g. anticoagulant therapy
• signs of spinal cord compression
• papilloedema or other signs of raised intracranial pressure
• suspicion of intracranial or cord mass
• congenital neurological lesions in lumbrosacral region

NICE suggest that in children and young people with suspected meningitis or suspected meningococcal disease, perform a lumbar puncture unless any of the following contraindications are present:

• signs suggesting raised intracranial pressure reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more)
  • relative bradycardia and hypertension
  • focal neurological signs
  • abnormal posture or posturing
  • unequal, dilated or poorly responsive pupils
  • papilloedema abnormal
  • 'doll's eye' movements "
• shock
• extensive or spreading purpura
• after convulsions until stabilised
• coagulation abnormalities
  • coagulation results (if obtained) outside the normal range
  • platelet count below 100 x 10^9/litre
  • receiving anticoagulant therapy
• local superficial infection at the lumbar puncture site
• respiratory insufficiency (lumbar puncture is considered to have a high risk of precipitating respiratory failure in the presence of respiratory insufficiency).

Reference:

• 1) NICE (June 2010). Bacterial meningitis and meningococcal septicaemia Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care