The Rational Clinical Examination
David L. Simel, Drummond Rennie
Lumbar Puncture
Sharon E. Straus, Kevin E. Thorpe, Jayna Holroyd-Leduc
Sections:
Patient Scenario, Methods, Results, Scenario Resolution, Bottom Line, References
Topics Discussed:
cerebrospinal fluid analysis, diagnostic spinal puncture
Excerpt:
"A previously healthy 70-year-old woman presents to the emergency
department with a 3-day history of fever, confusion, and lethargy.
She is unable to cooperate with a full physical examination, but
she has neck stiffness upon neck flexion. Her score on the Glasgow
Coma Scale is 13 (eye, 4; verbal, 4; motor, 5). The findings from
a chest radiograph and urinalysis are normal.1 You
seek consent from her husband to perform a lumbar puncture (LP).In a previous Rational Clinical Examination article, Attia and
colleagues1 discussed the above scenario and recommended
proceeding to LP for definitive testing of the cerebrospinal fluid
(CSF). Cerebrospinal fluid is a clear, colorless fluid that fills
the ventricles and subarachnoid space surrounding the brain and
spinal cord.2 Lumbar puncture allows this fluid
to be sampled, facilitating the diagnosis of various conditions...."
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