contraindications to lumbar puncture

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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:

Last reviewed 01/2018