Indications 1.Suspected CNS Infection : Meningitis /Encephalitis 2.Evaluate for Hemorrhagic CVA (Subarachnoid Hemorrhage): Hemorrhage suspected despite negative Head CT /Head CT not available 3.Diagnostic Chemistry Evaluation :CSF Gamma Globulin (Multiple Sclerosis) 4.CSF Dynamics :Spinal block diagnosis (Queckenstedt test) /Normal Pressure Hydrocephalus evaluation :Katzman infusion/Radionucleotide cisternography 5.CSF Cytology :Carcinomatous Meningitis /Lymphomatous Meningitis 6.Therapeutic lumbar puncture:Methotrexate infusion (CNS Leukemia)/ Amphotericin B infusion (fungal Meningitis)/ Removal of fluid to decrease Intracranial Pressure: Pseudotumor Cerebri /Headache associated with Subarachnoid Hemorrhage
Contraindications 1.Local infection at lumbar puncture site 2.Cerebral mass lesion (risk of herniation) :Large brain abscess/ Brain Tumor (especially posterior fossa)/ Subdural Hematoma /Intracranial Hemorrhage 3.Papilledema 4.Uncorrected Bleeding Disorder :Severe Thrombocytopenia
Complications Spinal Headache , Unexpected rise in Intracranial Pressure ,Worsening of spinal block, Nuchal Rigidity ,Involuntary muscle spasm limits passive neck flexion ,Patient cannot flex neck to place chin on chest, Spinal Rigidity, Erector spinae muscle spasm limits spine movement ,Opisthotonos (rigid arched back) may occur
Kernig's Signs (Test Sensitivity: 5% Test Specificity: 95% ) 1. Technique: Patient supine , Flex both hip and knee to 90 degrees , Hold hip immobile and extend knee 2.Positive Test suggesting Meningeal Irritation: Resistance to knee extension ,Pain in hamstrings
Brudzinski's Sign (Test Sensitivity: 5% Test Specificity: 95% )1.Technique :Patient supine ,Immobilize trunk against bed ,Flex neck, chin to chest 2.Positive Test suggesting Meningeal Irritation: Involuntary hip flexion
CNS infection(連結網站)
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