How to perform a Lumbar Puncture

Abstract

The first reports of a lumbar puncture (LP) being undertaken are from the late 19th century [1]. Heinrich Irenaeus Quince (with whom the Lumbar Puncture is commonly associated with) reported to the tenth congress of Internal Medicine in April 1891­­ that he had performed in one case 3 lumbar punctures in a patient with suspected tuberculous meningitis who was comatose [1,2]. The procedures were done at 3 day intervals and the patient recovered. The other case was in a patient that had chronic hydrocephalus and suffered headaches. Lumbar puncture in this patient relieved the symptoms. One month after Quincke’s report to the congress, Walter Essex Wynter, a Registrar at the time, published in the Lancet 4 cases of cerebrospinal fluid (CSF) aspiration in patients with meningitis suspected [3]. The Lumbar Puncture was a procedure dedicated to the relief of symptoms (at that time mainly meningitis or raised intracranial pressure) [4]. It has subsequently become a procedure that can be diagnostic or therapeutic, and the technique has become more refined with improved instruments, awareness of aseptic techniques and the increased availability and knowledge of anaesthesia.