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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Lumbar Puncture
Sharon E. Straus, Kevin E. Thorpe, Jayna Holroyd-Leduc
Patient Scenario


Topics Discussed: back pain, cerebrospinal fluid, cerebrospinal fluid analysis, diagnostic process, diagnostic spinal puncture, headache, neck pain, neuroimaging, pyrexia

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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