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Spinal tap

MagazineJune 2004 (Vol. 15 Issue 3)Spinal tap

There are no real alternatives to lumbar puncture, and few guidelines as to who should and should not have this procedure

There are no real alternatives to lumbar puncture, and few guidelines as to who should and should not have this procedure. It is contraindicated in brain oedema or swelling (such as from head trauma). In non-emergency situations, always ask your doctor if a diagnosis can be made without the test.

But if you must have a spinal tap, you can take precautions to ensure that your risk of adverse effects, especially headache, is low. For instance:

* Make sure your doctor is using an atraumatic needle

* Don't let a medical student perform the procedure

* Ask to sit upright rather than lie down.

Consider also whether you are one of those more likely to end up with PDPH (postdural puncture headache). It is more common among:

* Women, among whom it is twice a likely as in a man

* Labouring women receiving epidurals

* Those aged 18-30 years; the incidence is much less in children under 13 and in adults over 60

* Those who are underweight or who have a low body mass index (BMI)

* Those who suffer from chronic or recurrent headache or migraine
* Prior victims of PDPH.

If your lumbar puncture does result in a severe headache, consider these self-help measures:

* Maintain your fluid balance to support levels of CSF fluid while recovering

* While bed rest for a few hours after the procedure may be a good idea, resting for longer has no benefit. It may delay the onset of PDPH, but it won't decrease the incidence (Anesthesia, 1989; 44: 389-91; Br J Anesth, 1988; 60: 195-7)

* Caffeine is a CNS stimulant and cerebral vasoconstrictor that, in the short term, helps by restricting compensatory blood flow to the brain linked to PDPH (Anesthesiology, 1989; 71: A679) - 300 mg of an oral caffeine supplement is recommended

* In extreme cases, an injection of saline or application of a 'blood patch' (injecting a small amount of your blood into the space where the original puncture is) may be work, though these may be ineffective and can make things worse.

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