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The lumbar puncture represents introduction of a needle at the lumbar level in a spinal cord, namely, its subarachnoid space. Can be the purposes of carrying out such procedure: analysis of cerebrospinal fluid (liquor), anesthesiology and therapeutic effect.
In neurology the lumbar puncture is the most widespread diagnostic method. At subarachnoidal hemorrhage, infectious diseases of TsNS and in some other cases only this procedure can be the full-fledged basis for statement of the diagnosis. At neuroleukaemia, multiple sclerosis and polyneuropathies data of such analysis are additional, but extremely important, for receiving the overall clinical picture. Wide use of modern neurovisualization techniques, such as a magnetic and resonant tomography, a computer tomography, etc. allowed to reduce considerably quantity of the carried-out lumbar punctures with the diagnostic purpose.
Contraindications of carrying out a lumbar puncture
In case of suspicion on dislocation of a brain of carrying out this procedure strictly contraindicated. It is connected with the fact that pressure increased intrakranialno in combination with the lowered liquor pressure in spinal space can lead to processes of a vklineniye, and as a result – by a lethal outcome. In medical literature even one case when directly on a table for carrying out a lumbar puncture life of the patient ended with a lethal outcome is described.
In the presence in lumbosacral area of purulent processes it is better not to carry out a lumbar puncture, so it is dangerous by developing of purulent meningitis.
There are also other contraindications, but they are relative rather, in that case the doctor solves whether carrying out a puncture is possible.
Features of carrying out
For carrying out a lumbar puncture of the patient has to be sitting or lying, is more often in the last situation, on a rigid table on one side. The back is bent as much as possible, legs nestle on a body in the bent state. The puncture becomes between II and III or III and the IV vertebra. This place is caused by the minimum opportunity to injure a spinal cord, so it comes to an end at this level at the adult. For a local anesthesia usually use novocaine, 1-2% solution, layer-by-layer enter it in the place of future puncture. Between acanthas on the average line with an easy bias enter a needle Bira up. The feeling of a failure which arises approximately at a depth of 4-6 cm, means that the needle got to subarachnoid space. If after extraction of a mander liquid begins to expire, it speaks about the correct carrying out procedure. If the bone begins to be felt, the needle is got, having left the end in skin, and after change of the direction of the movement enter again. For the analysis usually collect no more than 120 ml of liquid. Its daily secretion makes about a halfliter, and 5 times a day are provided a regeneration.
Practically all complications as a result of a lumbar puncture are caused by the wrong carrying out this procedure. Disturbance of equipment can become an origin of a post-puncture cholesteatoma of a spinal cord which is connected with transfer in covers of a spinal cord of cells of an epithelium. It is possible to distinguish various infections, a pain syndrome within several days after carrying out procedure from other complications, an intracranial subdural, intracerebral and subarachnoidal hematoma. Also introduction of a needle can damage roots of nerves that leads to disk herniations because of its traumatizing. In that case when contrast agents, anesthetics, air, chemical drugs and antibacterial are entered into a subarachnoid space, there can be a meningeal reaction of various degree. Sometimes it leads to a myelitis, an arachnoiditis, radiculitis. It is possible to distinguish a headache, vomiting, nausea, dizziness which amplify in case of attempt by the patient to be roused from the most insignificant and quickly taking place complications. As for pregnant women, the lumbar puncture is especially dangerous to them. Its carrying out can provoke an abortion. Also vazovagalny reactions which are dangerous by disturbance of cardiac performance, an apnoea, so and a brain hypoxia can develop.
The mode after procedure
Some specialists right after carrying out a puncture allow the patient to go as consider what cannot save lying situation from emergence of a post-puncture syndrome. However, most of doctors nevertheless recommend a bed rest, namely three-four hours lying on a stomach. Some patient intravenously enters plasma substitutes, plentiful warm drink is considered also useful. The bed rest can even reach three days when in a subarachnoid space any drugs are administered.