Lumbar Puncture - Contraindications

Contraindications

Lumbar puncture should not be performed in the following situations

• Idiopathic (unidentified cause) increased intracranial pressure (ICP)
  • Rationale: lumbar puncture in the presence of increased ICP may cause uncal herniation
  • Exception: therapeutic use of lumbar puncture to reduce ICP
  • Precaution
    • CT brain is advocated by some, especially in the following situations
      • Age >65
      • Reduced GCS or conscious state
      • Recent history of seizure
      • Focal neurological signs
    • Ophthalmoscopy for papilledema
• Bleeding diathesis
  • Coagulopathy
  • Decreased platelet count (<50 x 109/L)
• Infections
  • Skin infection at puncture site
  • Sepsis
• Abnormal respiratory pattern
• Hypertension with bradycardia and deteriorating consciousness
• Vertebral deformities (scoliosis or kyphosis), in hands of an inexperienced physician.