When Is Lumbar Puncture Contraindicated?

Although lumbar puncture can be an important diagnostic procedure, there are times when it is contraindicated.

The APLS Contraindications to Lumbar Puncture 

  • Prolonged or focal seizure
  • Focal neurological signs ( including ocular palsies)
  • Widespread purpuric rash in ill child
  • Glasgow coma score <13
  • Pupillary dilatation
  • Impaired oculocephalic reflexes
  • Abnormal posture
  • RICP: inappropriately low pulse, elevated blood pressure and irregular respirations. (indicating impending brain herniation)
  • Coagulopathy
  • Papilloedema
  • Hypertension

Lumbar puncture should also be avoided where there is any cardiovascular or respiratory compromise or if there is local infection at the site of LP.

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