THE TRUTH ABOUT LUMBAR PUNCTURE
During one post-admission round, a senior doctor asked why the patient who came in
unconscious the previous night was still being managed empirically and not with specific
meds…the junior doctors’ response was that the relative had refused to authorise a lumbar
puncture to be done and had signed in the file against it. This was one of the many cases I
have seen where patients or relatives refuse consent for a lumbar puncture to be done. A
simple response when asked why they refuse is always that they don’t think it is entirely
necessary. The core of the answer however is the fear of imminent death once the
procedure is performed. I too before I became a medical student had heard of many stories
of how people had ‘died after a lumbar puncture’ had been done on them. I pictured it as a
very invasive procedure that was probably performed with the patient positioned upside
down or ‘turned inside out.’
How did we get here in the first place? Well am not too sure how, but have heard that in the
past lumbar punctures were performed too late that the damage done by the disease was
too extensive or irreversible leading to death because either the health practitioner thought
to turn to it as a last resort or that the relatives (or patient) gave the consent rather too late.
Whichever the case, the patients died not because the lumbar puncture had been done on
them but because of the extensive infective process that was going on…Many probably then
went about propagating how that the patient died after lumbar puncture. In my opinion to
attribute death to a lumbar puncture is like blaming a bystander of murder when the actual
shooter with a gun is right before us.
I have seen so many lumbar punctures being done, most of which were during my surgical
rotations for administration of anaesthesia and not a single patient ever died as a result of a
lumbar puncture.
Simply put, a lumbar puncture is a procedure that involves the introduction of a needle into
a space (called the subarachnoid space) in the spine (backbone) for the purposes of
obtaining cerebrospinal fluid (CSF) or administration of anaesthesia. It’s called lumbar
because it’s done on the lumbar part of the backbone. The CSF is a fluid that is produced in
the brain and so gives a lot of diagnostic information of possible life threatening conditions
such as bacterial meningitis or bleeding into the subarachnoid space. A lumbar puncture can
also be used to relieve increased intracranial pressure when there is so much CSF within the
skull.
How does it help? I will skip over to what mostly affects us in our setting which is meningitis
(a serious and often deadly disease in which an outside layer of the brain or spinal cord
becomes infected and swollen). Many kinds of microorganisms can cause meningitis but the
most notorious are bacteria. Because there are so many types of bacteria some of which
have even become resistant to certain drugs used in treatment, it becomes imperative that
the specific infecting bacteria in a patient is isolated and tested in the laboratory to see
which drug is the most suitable to be used for treatment in that particular patient. Instead
of having to shoot in the stars with use of various combinations of drugs, specific treatment
can only be confirmed after lumbar puncture. All this information can only be obtained from
the CSF which is accessed via a lumbar puncture, a procedure that lasts less than 5 minutes to perform. The earlier the specific treatment is initiated the better the outcome and the lesser the possible complications of the infective process (seizures, brain abscesses, death, etc)
What are the possible complications of a lumbar puncture?
As can be seen most of these complications are not permanent and avoidable e.g by use of a smaller needle, lying down for some time after the procedure and use of aseptic techniques by the health practitioner. Of important notice is that DEATH is not one of the complications of a lumbar puncture.
Next time you hear of a lumbar puncture being done or that a patient or relative needs one, gladly embrace it because it’s a NEEDED step towards their specific treatment. Remember, the earlier it is done the better. Do not DELAY consent.
unconscious the previous night was still being managed empirically and not with specific
meds…the junior doctors’ response was that the relative had refused to authorise a lumbar
puncture to be done and had signed in the file against it. This was one of the many cases I
have seen where patients or relatives refuse consent for a lumbar puncture to be done. A
simple response when asked why they refuse is always that they don’t think it is entirely
necessary. The core of the answer however is the fear of imminent death once the
procedure is performed. I too before I became a medical student had heard of many stories
of how people had ‘died after a lumbar puncture’ had been done on them. I pictured it as a
very invasive procedure that was probably performed with the patient positioned upside
down or ‘turned inside out.’
How did we get here in the first place? Well am not too sure how, but have heard that in the
past lumbar punctures were performed too late that the damage done by the disease was
too extensive or irreversible leading to death because either the health practitioner thought
to turn to it as a last resort or that the relatives (or patient) gave the consent rather too late.
Whichever the case, the patients died not because the lumbar puncture had been done on
them but because of the extensive infective process that was going on…Many probably then
went about propagating how that the patient died after lumbar puncture. In my opinion to
attribute death to a lumbar puncture is like blaming a bystander of murder when the actual
shooter with a gun is right before us.
I have seen so many lumbar punctures being done, most of which were during my surgical
rotations for administration of anaesthesia and not a single patient ever died as a result of a
lumbar puncture.
Simply put, a lumbar puncture is a procedure that involves the introduction of a needle into
a space (called the subarachnoid space) in the spine (backbone) for the purposes of
obtaining cerebrospinal fluid (CSF) or administration of anaesthesia. It’s called lumbar
because it’s done on the lumbar part of the backbone. The CSF is a fluid that is produced in
the brain and so gives a lot of diagnostic information of possible life threatening conditions
such as bacterial meningitis or bleeding into the subarachnoid space. A lumbar puncture can
also be used to relieve increased intracranial pressure when there is so much CSF within the
skull.
How does it help? I will skip over to what mostly affects us in our setting which is meningitis
(a serious and often deadly disease in which an outside layer of the brain or spinal cord
becomes infected and swollen). Many kinds of microorganisms can cause meningitis but the
most notorious are bacteria. Because there are so many types of bacteria some of which
have even become resistant to certain drugs used in treatment, it becomes imperative that
the specific infecting bacteria in a patient is isolated and tested in the laboratory to see
which drug is the most suitable to be used for treatment in that particular patient. Instead
of having to shoot in the stars with use of various combinations of drugs, specific treatment
can only be confirmed after lumbar puncture. All this information can only be obtained from
the CSF which is accessed via a lumbar puncture, a procedure that lasts less than 5 minutes to perform. The earlier the specific treatment is initiated the better the outcome and the lesser the possible complications of the infective process (seizures, brain abscesses, death, etc)
What are the possible complications of a lumbar puncture?
- Severe headache that is worse when upright and better when lying down. This resolves within hours or over several days (3 or 4 days). Despite being the most common complication that occurs in between 10-30% of patients I’m yet to see one.
- Bleeding that forms a clot (spinal epidural hematoma)
- Infection at the site
- Temporal loss of sensation
As can be seen most of these complications are not permanent and avoidable e.g by use of a smaller needle, lying down for some time after the procedure and use of aseptic techniques by the health practitioner. Of important notice is that DEATH is not one of the complications of a lumbar puncture.
Next time you hear of a lumbar puncture being done or that a patient or relative needs one, gladly embrace it because it’s a NEEDED step towards their specific treatment. Remember, the earlier it is done the better. Do not DELAY consent.
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