Precautions for lumbar puncture: A survey of neurologic educators
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Two major risks of diagnostic lumbar puncture (LP) are brainstem compression due to cerebellar and cerebral herniation and cauda equina compression due to epidural hemorrhage. The American Academy of Neurology acknowledges both these dangers in its 1993 Quality Standards Subcommittee report on LP practice parameters.1 For the first risk, the report simply notes that CT imaging is better than clinical findings at predicting cases of increased intracranial pressure caused by a mass lesion or obstruction of the ventricular system. For the second risk, the report states only that coagulation defects and therapeutic anticoagulation result in an undefined level of increased risk of epidural hemorrhage. To learn about current concepts related to these risks, we surveyed neurologic educators on whether routine brain imaging and coagulation studies are necessary before LP.
Materials and methods.
We sent a survey to the 246 pediatric and adult …
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