Lumbar puncture

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Lumbar puncture

Lumbar puncture, also known as the spinal tap is an invasive diagnostic procedure carried out to collect a sample of cerebrospinal fluid. The fluid is collected for cytological, microbiological or biochemical investigation or at times to relieve the excess pressure in the cerebrospinal fluid pressure. This test is used to make a diagnosis or rule out primary or metastatic brain or spinal cord neoplasm, meningitis, encephalitis, autoimmune diseases of the central nervous system or cerebral hemorrhage.

The patient is requested to lie in the lateral position (on his/her side) on the bed to prepare for a lumbar puncture. The patient is made to lie perpendicular to the bed in a fetal position. A spinal needle is inserted either between the L3/L4 or L4/L5 and is pushed till the needle goes past the dura mater. The cerebrospinal fluid is then collected by removing the stylet from the spinal needle. The pressure of the cerebrospinal fluid is measured before and after extracting the sample. The entire lumbar puncture procedure takes about 20 minutes.

Encephalitis

Encephalitis in an acute inflammation of the brain. Caused by herpes simplex virus, encephalitis causes cerebral edema thereby destroying nerve cells. This may lead to bleeding in the brain and brain damage. Encephalitis is often caused by the virus that causes mumps, measles, rabies, polio and rubella. Symptoms of encephalitis may begin with a stomach infection, headache and fever. It can also manifest in vomiting, drowsiness and clumsy gait. Severe headache and muscle or loss of consciousness are severe symptoms.

Brain MRI and CT scan of the head might be necessary to diagnose encephalitis. Serology tests and lumbar puncture and CSF examination might be done. Examination of the patient might show increased intracranial pressure, abnormal reflexes and mental confusion. The patient is given nutrition through fluids and anti-viral medicines such as acyclovir and foscarnet. Anti-seizures might be given. Antibiotics are prescribed in case the infection is caused by bacteria.

Ataxia

Ataxia is a condition that indicates lack of muscle control during voluntary movements like picking up objects or walking. In other words it refers to the loss of coordination of muscular movement. Ataxia can affect speech, eye movement, swallowing etc. Persistent ataxia in a person may be due to damage in the cerebellum, i.e. the part of the brain that controls muscle coordination. For example, gait ataxia refers to the condition of walking difficulties owing to a tumor in the brain stem. There are different types of ataxia:

Friedreich's Ataxia
Spinocerebellar Ataxia type 6
A less common type is Ataxia Telangiectasia

Ataxia causes

Damage or degeneration to the nerve cells in the brain that controls muscle coordination causes ataxia. Diseases damaging the spinal cord and peripheral nerves connecting the cerebellum and muscles may cause ataxia. Other common causes for Ataxia include:

Damage or degeneration of nerve cells in the part of the brain that controls muscle coordination.

Head trauma

Vitamin B12 deficiency

Brain tumor

Hereditary - in a few cases, an inherited gene may have caused the condition.

Alcohol abuse

Multiple sclerosis

Toxic reaction

Ataxia symptoms

Ataxia may develop over a period of time or may show up suddenly. Common symptoms include:

Poor coordination
Change in speech
Stumbling while walking
Difficulty in fine motor tasks like eating, buttoning the shirt, writing, etc
Difficulty in swallowing
Involuntary eye movement
Confused facial expressions
Problems with balance
Cold feet due to poor muscle activity
Vision problem
Hearing problem
Body tremors

Cerebellum ataxia

Dysfunction of cerebellum leads to this condition. Based on whether the cerebellum has lesions on one or both sides, the symptoms may vary. This condition may set in between the ages of 4 and 26 and can cause the following symptoms:

Asynergy (lack of coordination between organs, limbs, joints or muscles)

Hypotonia

Dysdiadochokinesia - inability to perform rapid, alternating movements

Dysmetria - impaired ability to control distance, speed and power of an arm, leg, hand or eye movement

Dyschronometria - difficulty in estimating the time that has passed.

Sensory ataxia

Proprioception (sense of relative position of neighboring parts of the body) is lost in this condition. A person suffering from this condition may face the following symptoms:

Unsteadiness or stumbling while walking/moving around.

With each step, the heel strikes hard while touching the ground.

Postural problems in poorly lit conditions.

Difficulty in performing voluntary movements.

Vestibular ataxia

Vestibular system is affected and so the following symptoms may be experienced:

Vertigo

Nausea

Vomiting

Ataxia diagnosis

Diagnosis for ataxia include the following

Imaging studies including CT, MRI help diagnose the condition. Shrinkage of the cerebellum and other brain structures can be studied using MRI.

Genetic testing helps in diagnosing hereditary ataxia.

Lumbar Puncture

Ataxia Treatment

Though there is no specific treatment for ataxia, in a few cases treating the underlying cause can cure the condition. Virus induced ataxia gets cured on its own with time. The other available common treatments for ataxia include:

Therapies such as speech therapy in case of slurred speech, occupational therapy to handle day to day tasks and physical therapy to build strength of muscles and enhance its mobility.
Tags: #Lumbar puncture #Encephalitis #Ataxia

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