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Many colleagues before me have written widely through various forums about a Lumbar puncture procedure to try and educate the public and quell some fears and misconceptions surroundings this potentially lifesaving procedure.
There is however still a lot of fear out there surrounding this particular procedure, a fact that I got reminded of this past week when I saw a case of patient who needed this procedure. The first patient declined to have the procedure done and said will come back to hospital after consultation with the family, which they never did. Thankfully the second patient after a long discussion agreed to have it done. After finishing the procedure in about 15 minutes or so, he was surprised how quick it was and he told me how he had been misinformed.
A lumbar puncture is a procedure that is commonly done to aspirate cerebrospinal fluid (CSF) in the lower back. This done usually to make a diagnosis of meningitis, which is inflammation or infections of the meninges. The meninges are a membrane that is covering the brain. In between the brain and the meninges is the CSF which then goes down surrounding the spinal cord and can be tapped at the lower back, just below where the spinal cord ends.
The procedure is usually done when there is a clinical suspicion of meningitis, based of symptoms of fever, neck pain and headache. It helps in distinguishing the specific causes of meningitis, as it can be caused by bacteria, viruses, fungi and Tuberculosis and the treatment of each is different.
When the procedure is performed, the patient is awake. A common misconception is that the patient must be taken to the operating room and be operated. Some people also believe that the CSF is aspirated at the base of the neck, which is also a misconception. The fluid is aspirated at the lower back after giving some local anesthetic to numb off the pain.
Complications of this procedure are very rare. Common complications include pain at the site of injection, or a sharp pain that runs down the leg if a nerve is hit by mistake. Other complications include bleeding or swelling at the site of injection. Some patients may experience a severe headache after the procedure. This often resolves after bed rest of 30 to 45 minutes. A big misconception is that this procedure can cause death. Death from this procedure is unheard off.
Individuals who often die, die from the complications of their disease. As I have alluded this procedure is done to exclude meningitis which is a very serious condition associated with high death rates particularly if treatment is started late or in the setting of advanced HIV. Most of the misconceptions we have surrounding this procedure started when we had very high numbers of people with advanced HIV presenting to hospital with complications.
A lumbar puncture is a relatively safe procedure with minimal complications. We need to continue educating the public more, so we can alleviate their fears and put away all the misconceptions they have about it, because at the end of the day it saves lives.