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.

Cisternography

Cisternography involves radiographic study of the brain's basal cisterns. An opaque contrast medium is introduced into the lower back through a spinal tap. Cisternography is often conducted along with CT scan or MRI. The neurologist or neurosurgeon can take a decision whether or not to opt for shunt surgery.

Reye's Syndrome

Though the occurrence of Reye's Syndrome is rare, it is a potentially life-threatening condition. Typically, a patient suffering from Reye's syndrome has elevated levels of ammonia and acidity in the blood and reduced blood sugar levels. There is swelling in the liver and in serious cases in the brain. This can lead to a comatose condition. Usually this syndrome occurs in children under 15 years; though there has been a substantial decrease in the number of cases. Usage of aspirin to treat a viral infection is thought to be one of the factors that triggers Reye's syndrome in children and teenagers. Often Reye's syndrome is confused with meningitis, encephalitis or mental illness. It is essential to treat this condition in the early stages, lest it lead to permanent brain damage. Usually Reye's Syndrome is preceded by a viral illness. The symptoms of Reye's syndrome are nausea, rapid breathing, unusual sleepiness and lethargy. Other symptoms are persistent vomiting and diarrhea. The affected child might exhibit bizarre behavior. In a matter of a few hours, the condition can worsen and there can be seizures or convulsions and loss of consciousness. There may be muscle function loss or paralysis of the arms or legs.

A child affected by Reye's Syndrome must be given adequate fluids and electrolytes. It is essential There must be balanced and nutritional food. If there is difficulty in breathing, a respirator can provide relief. Medication is given to reduce intracranial pressure. Avoid food that upsets the child's stomach and try and keep the fever under control. A variety of diagnostic tools ranging from head CT Scan or MRI to spinal tap (lumbar puncture) and liver biopsy can help in detecting Reye's syndrome. In addition to blood and urine tests, a spinal tap is conducted to rule out meningitis or encephalitis. Liver biopsy is useful in ruling out diseases of the liver.