Talk:Lumbar puncture

message: I think its worth noting in the procedure section that the lumbar puncture must also penetrate the arachnoid. - JRS  —Preceding unsigned comment added by 155.58.11.16 (talk) 21:29, 12 June 2008 (UTC)

message: How long do the headaches last after a spinal tap has been done?
:Hours to days, depending on the speed by which the CSF was drained. Some people keep on "seeping" CSF into their epidural space; they sometimes require a "blood patch" to stop this; the headaches resolve almost instantly. JFW | T@lk 07:41, 7 Feb 2005 (UTC)
thread_title: Question

message: The article says, 'Some authorities believe that withdrawal of fluid when initial pressures are too low could result in spinal cord compression or cerebral herniation...' 
Cerebral herniation is accepted in standard texts as a well known complication of raised intracranial pressure which may occur with space occupying lesions in the brain. If what the article claims is well researched, it should be presented as an adjunct to this fact which surprisingly doesn't find a mention. 
:. JFW | T@lk 13:49, 28 December 2005 (UTC)
replies: text: I'm the author of the text you quoted.  I can't tell whether your criticism is because you think it's obvious that LP can cause cerebral herniation, or because you think it's obvious that LP could never cause cerebral herniation and that it must always be due to the presence of space-occupying lesions in the brain and never due to LP.  -Ikkyu2 02:58, 30 December 2005 (UTC)

text: Oh, I see what your deal is.  It's not whether the LP is causative, but the phrase "initial pressures too low."  The idea is that in obstructive hydrocephalus the spinal pressure is significantly lower than the above-obstruction pressures, and that lowering it further can worsen the pressure gradient and cause herniation.  Not everyone believes this, and even the 'too low' measured pressure is usually higher than normal in this model.  I will modify the statement to weasel around this and please everyone, regardless of their interpretation of the Monroe-Kellie doctrine.  -Ikkyu2 03:02, 30 December 2005 (UTC)

text: The article is still devoid of this. Some studies say that neuroimaging is only required if there is a suspected mass lesion, while other recommend it in focal signs, decreased level of consciousness or signs of raised ICP (papilloedema, decerebrate positioning etc.) I personally have never seen any junior doctor in the UK do an LP without a CT scan, probably because they are easy to obtain in patients whose history is bad enough to warrant an LP. JFW | T@lk 13:14, 21 January 2008 (UTC)
thread_title:  Complication of LP 

message: Since one can never be sure of the reasons that a reader might be searching for this article, I wonder if it might be worthwhile to include a mention of the urban myth that spinal taps are "routinely" performed to determine if someone has used LSD.  Perhaps a brief mention in a newly added "Trivia" section would be in order. - Ugliness Man 11:24, 23 February 2006 (UTC)
replies: text: Sources please for the urban myth? JFW | T@lk 13:14, 21 January 2008 (UTC)
thread_title:  Trivia? 

message: I heard someone on the radio say that a lumbar puncture is the most painful thing in the world ever... exactly how painful is it? --124.180.103.210 09:55, 25 June 2007 (UTC)
replies: text: Child birth?  —Preceding unsigned comment added by 71.86.54.3 (talk) 05:44, 29 March 2008 (UTC)

text: See comment below. It is probably nonsense. No it is not.JFW | T@lk 13:14, 21 January 2008 (UTC)

text: It sounds awful. But how certain are you that no local anaesthetic was used? Lidocaine, when injected under the skin, gives a pretty nasty burning sensation that precedes the numbness. JFW | T@lk 13:14, 21 January 2008 (UTC)
thread_title:  Most painful thing ever 

message: doi:10.1111/j.1365-2141.2009.07899.x review of safety of LPs in people with low platelets. JFW | T@lk 18:29, 15 December 2009 (UTC)
thread_title: Platelets

message: The doctor tried doing a lumbar puncture without success.  The local medication used did not numb the area and when the puncture needle was being inserted, I felt lots of pressure and pain.  I have very sensitive nerves due to polyneuropathy.  The doctor tried two or three times and just gave up as I was moving around too much and he couldn't take the chance of doing it.  My Neurologist is trying to rule out CIDP and other muscular diseases.  I was wondering if this procedure can be done using IV sedation?  An answer would be very appreciated.
70.173.117.53 (talk) 11:12, 2 April 2010 (UTC)
replies: text: I'm sure this is done occasionally, but you should discuss this with your neurologist in the first instance. JFW | T@lk 10:46, 2 March 2014 (UTC)
thread_title:  Can IV sedation be used when a doctor does a lumbar puncture? 

message: I love reading about medical things but actual pictures of it make me go berserk. Is there any way to like turn of medical pictures or things like this? An option or anything? 71.161.201.163 (talk) 14:17, 24 February 2011 (UTC)
replies: text: Your browser should have a setting for that. Wikipedia is not censored, so I'm afraid you can't get us to do it for you. JFW | T@lk 10:46, 2 March 2014 (UTC)
thread_title: Pictures

message: Is this procedure typically done by a neurologist or surgeon, or is it also done in primary-care practice?  Or, do physician assistants and advanced-practice registered nurses (nurse-anesthetists or nurse-practitioners)  also do it? 74.96.75.216 (talk) 04:21, 11 January 2014 (UTC)
replies: text: Difficult to answer without a source. In the UK it is done almost invariably by doctors. JFW | T@lk 10:46, 2 March 2014 (UTC)
thread_title:  Who does it? 

message: The article needs work, but things could be worse. Per WP:MEDMOS, we should be grouping "contraindications" under "indications" and we should discuss the principles of the procedure under a section called "Mechanism" before describing the actual procedure in "Procedure". The analysis and interpretation comes under a further section called "Interpretation", followed by "Adverse effects" and finally "history". I will make these changes.
# Indications - build this on 1-2 sources (journal and/or textbook)
# Mechanism - expand using Wright and at least 1-2 other sources
# Procedure - make prose a little less dense, add information about fluoroscopy and ultrasound as adjuncts in difficult procedures
# Interpretation - rearrange using less bullet points, perhaps converge towards less sources
# Adverse effects - Wright reviews this in detail
# History - some expansion needed
Sources:
* I am keen to drop Sempere and Gröschel as sources considering they're not in English and there are other English papers available
* All sources that don't comply with WP:MEDRS should be dropped
* We could get more information from Straus and Roos
* Wright doi:10.1007/s00415-012-6413-x is a strong source that can help
*  (Cooper 2011) has some stuff that might complement the other sources
No timeframe is intended, but the above are my intentions. JFW | T@lk 12:17, 14 March 2014 (UTC)
thread_title:  Updating 

message: Not mentioned in article. 109.157.79.50 (talk) 04:33, 9 January 2015 (UTC)
thread_title:  Why do "rachicentesis" and "rachiocentesis" redirect here? 

message: Just a few comments and suggestions for this article, broken down by section:
The Lead:
I like how concise the lead is. You may want to add a definition of "Cerebellar tonsils herniation" to something more easily readable to general population, such as "compression of brain tissue". Potential to place citations throughout the lead, as there are currently no citations present in the lead.
Medical uses and Indications:
Might want to add in "therapeutic" section of doing LP's pseudo-tumor cerebri.
Contraindications:
May want to clarify if something is an absolute vs relative contraindication.
Adverse effects:
The content of this section is good. I would try to cut down on the sentence length, as some of them are quite long.
Citations would be helpful in the 3rd paragraph of Adverse effects (the paragraph beginning with "The procedure us not recommended when…"
Technique:
I really like the pictures on the side depicting patient positions and the needle piercing the appropriate layers. Citations would be helpful for certain paragraphs within this section, including the 2nd paragraph "The upright seated position…" and 3rd paragraph "Patent anxiety during…" within the procedures section.
For the special consideration for pediatric patients, you can leave out the "One study with 132 patients compared…" part and just treat it as a statement. No need to add in methodology to a specific study.
Interpretation:
Good organization, I like the included table with citations.
Overall, very good improvements to the article!
-  — Preceding unsigned comment added by Glam316 (talk • contribs) 20:58, 14 November 2015 (UTC)
thread_title:  Peer Review 

message: The pressure of the CSF at lumbar puncture is often referred to as opening pressure but I have not seen, in Wikipedia or elsewhere, any explanation of the meaning intended by the word opening in this context. The article uses the expression three times, but the rest of the time refers only to pressure or CSF pressure; the article on CSF does not use the expression. Does anyone know what opening pressure conveys that pressure does not? Moletrouser (talk) 13:19, 12 March 2017 (UTC)
replies: text: The precise etymology of "opening pressure" isn't clear to me, but if CSF is removed then the pressure recorded at the end of the procedure is called the "closing pressure". I therefore presume that it is the pressure at the "opening" of an LP session. If I come across anything else I will add it. JFW | T@lk 15:36, 14 February 2018 (UTC)
thread_title:  Opening Pressure? 

message: doi:10.1016/S1474-4422(18)30033-4 review by the Dutch meningitis people. JFW | T@lk 15:36, 14 February 2018 (UTC)
thread_title: Lancet Neurology

message: — Assignment last updated by Apetko3 (talk) 09:04, 9 November 2023 (UTC)
thread_title: Wiki Education assignment: Wikipedia for the Medical Editor