Indications for Lumbar Puncture

Abstract

To the Editor.— I read the answers of Herbert N. Hultgren, MD (241:2549, 1979), to the questions concerning anticoagulation therapy for stroke in evolution. Concerning the CSF examination to exclude hemorrhage or hemorrhagic infarction, the following recommendations serve as guidelines for those considering spinal puncture. In the presence of an intracerebral hematoma, lumbar puncture entails a risk of tentorial or cerebellar herniation. If computerized axial tomographic examination shows no evidence of a mass lesion, uniformly blood-stained CSF may be sought. 1 The accurate diagnosis of meningitis, meningeal carcinomatosis, 2 and diseases requiring CSF globulin quantitation 3 requires completion of spinal puncture. With evidence of intracranial mass lesions, lumbar puncture rarely generates information sufficient to justify complications. 4