At what puncture are they discharged home with meningitis? How to diagnose meningitis in children: necessary studies and tests

Meningitis is a serious disease that is an inflammation of the lining of the spinal cord and brain. Despite the fact that scientists have been trying to fight this disease for many years, it is difficult, especially in children. During its course, it is the child (especially the little one) who has characteristics that you need to know about.

Signs and symptoms

Although all children experience meningitis differently, there are a number of symptoms that are common to all forms. Meningeal symptoms include the following:

headache, severe and aggravated by external factors ( loud noise, bright light);
vomiting without nausea, not related to food in any way;
high temperature (39-40 C), not responding to conventional antipyretic drugs;
the baby may complain that he does not feel the back of his head and back; gently place him on his back and ask him to press his chin to his chest; he will not be able to do this due to muscle stiffness;
in a baby you can notice a bulging of the large fontanel and its strong tension;
It is more comfortable for the patient to lie on his side, with his legs tucked close to his stomach and his head thrown back;
With meningitis, a rash may begin, sometimes reaching large, bright burgundy spots all over the body.

Since the meningeal symptom can be recognized by parents at home, at its first manifestations it is necessary to immediately go to the hospital. Moreover, the causes of meningococcal infection can be various factors.

The causes of this disease in children can be:

viruses, bacteria, fungi, protozoa;
sepsis and birth injuries in newborns;
problems with the nasopharynx and middle ear in young children (up to one year);
prematurity;
decreased immunity;
diseases nervous system;
spinal cord and brain injuries.

Therefore, children suffering from such deviations and health problems are at risk. The incubation period of the disease ranges from 1 to 10 days.

Types of meningitis

Meningitis among children is divided into two groups.

1. Purulent
Caused by a bacterial infection. It affects the youngest children, who are not even one year old. Most often they start with severe chills, fever, vomiting and headaches. Meningeal syndromes are very clearly expressed.

2. Serous
The cause is a viral infection. This type of disease most often occurs in children. It can be caused by mumps viruses (mumps in children), some intestinal viruses (ECHO, Coxsackie). Affects children from 1 to 8 years of age. It begins unexpectedly with a sharp jump in temperature to 39-40 C and higher. This acute period lasts from 3 to 5 days, and full recovery hopefully in 2 weeks.

The outcome of both forms of the disease depends on timely consultation with a doctor and the adequacy of treatment, but in the case of serous meningitis there is a greater chance of a quick recovery without consequences. The purulent type is both diagnosed and treated with difficulty.

Diagnostics

Diagnosis of serous childhood meningitis is not difficult, unlike purulent meningitis, which is recognized only during laboratory examinations. If meningitis is suspected, children are prescribed the following procedures:

Cerebrospinal fluid puncture.
General blood analysis.
CSF analysis.
Bacterioscopic examination of blood smears and cerebrospinal fluid sediment.
Bacteriological cultures of blood, cerebrospinal fluid, mucus from the nasopharynx.

There are a lot of tests, all this is done to make an accurate diagnosis. Before taking a puncture from a child, he is sent for examination to an ENT specialist, neurologist, neurosurgeon and hematologist in order to avoid consequences.

Self-medication in case of meningitis is unacceptable. Treatment of the child should be carried out under the supervision of a doctor in a hospital setting. This disease is dangerous because the patient’s condition can worsen at any time and become critical. Then emergency resuscitation measures are carried out, possible only in clinical settings. The course of treatment involves taking antiviral and antibacterial agents and will depend on the form of the disease.

1. Treatment of serous meningitis
Therapy in these cases is aimed primarily at reducing intracranial pressure. Therefore, the patient is given diuretics, desensitizing (relieving allergies) and restoratives, various vitamins.

2. Treatment of purulent meningitis
Here therapy is based solely on antibacterial drugs, which are prescribed only based on the results of laboratory tests. Anti-intoxication and diuretics are administered intravenously using droppers.

Antibiotics

In both cases, antibiotics are prescribed penicillin series: amoxil, flemoxin, benzylpenicillin. They are used for treatment for no longer than 5–7 days. Piracetam or nootropil is prescribed to restore nerve cells and blood vessels. Dexamethasone, Kenalog, hydrocortisone and methylprednisolone are anti-inflammatory therapies.

Rehabilitation

After the course of treatment, the child is allowed to lead a normal lifestyle, since meningitis does not damage the main systems of the child’s body.

Complications after meningitis

If meningococcal infection in a child was detected in a timely manner, doctors and parents took everything possible measures, aimed at eliminating the disease, there is no need to be afraid of serious consequences. If going to the hospital was not timely, with purulent forms, as well as if the baby has health problems, the following consequences may be observed:

complete deafness;
blindness;
mental and physical developmental delay;
toxic shock;
edema, swelling of the brain;
acute adrenal failure;
Cerebroasthenia.

As sad as it may be, sometimes meningitis can lead to death.

Prevention

Due to the fact that the treatment of childhood meningitis is a complex and protracted process, prevention is important of this disease. First of all, parents of those children who are at risk should think about it. The most effective preventive measures are:

Meningitis vaccinations given to children at an early age: now used for this purpose different vaccines meningococcal, pneumococcal conjugation (injected before the age of two years) and polysaccharide (injected into those over 5 years old), trivaccine against measles rubella, measles, mumps and protects against meningitis, as well as a vaccine against chickenpox;
chemoprophylaxis for anyone who has been in contact with a person with meningitis;
Since the disease is transmitted by airborne droplets, it is necessary to refrain from contact with carriers of the infection, using gauze bandages and respirators.

Meningitis is a dangerous and serious disease from which you must protect your child. If the circumstances turn out to be stronger, parents need to take all measures to get well soon baby. This is the only way to avoid severe consequences and complications of this disease.

Taking a sample of the cerebrospinal fluid (CSF) allows you to accurately identify the nature of the disease (bacterial or viral) and, accordingly, create an effective treatment plan.

The procedure has not only diagnostic utility. By removing a small amount of cerebrospinal fluid, increased intracranial pressure, which causes painful headaches, is reduced.

How is puncture performed for meningitis?

The patient is placed on his side, asked to pull his legs to his chest and lie still. The doctor's assistant monitors the maintenance of the desired posture.

The target area in the lumbar region is disinfected. Then, at its level, a puncture of the spinal canal is made with a special needle. The needle is inserted into the subarachnoid space.

The patient experiences far from the most pleasant sensations, but against the background of the general serious condition they are not perceived as a big shock.

The procedure takes place quickly - within just seven to ten minutes.

In some forms of meningitis, punctures are done not to establish a diagnosis or to reduce pressure, but primarily to directly administer an antibiotic. For example, repeated endolumbar administration of streptomycin is the main therapeutic measure with tuberculous inflammation of the spinal cord membranes.

Is a spinal tap dangerous?

There is a popular opinion that this procedure often makes a person disabled - they say, the doctor can awkwardly touch the nerve endings, and the legs will be paralyzed.

Such statements should not be believed. The puncture is performed in an area that is poorly innervated. A complication such as paralysis is extremely unlikely. In the worst case, complications will include meningeal meningeal symptoms:

A puncture can lead to undesirable consequences unless there are contraindications for its implementation. The latter include: axial displacement of the brain, occlusive hydrocephalus, blood coagulation pathologies.

Multiple punctures (as with the above tuberculous meningitis) can subsequently lead to the development of implantation cholesteatomas of the spinal canal. But this complication is still better than death as a result of progressive inflammation of the spinal cord membranes.

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Lumbar puncture as an integral part of the diagnosis of meningitis

Lumbar puncture is a manipulation in which a needle is inserted into the subarachnoid space for diagnostic or therapeutic purposes. More often this technique performed for a disease such as meningitis (inflammation of the meninges). With this disease this manipulation is one of the key stages in diagnosis, as it allows you to confirm or exclude the presence of the diagnosis itself, as well as clarify the pathogen that caused this or that type of meningitis.

The patient in the lying and sitting position during lumbar puncture

Most patients at the word “ lumbar puncture” represents a dangerous and quite painful manipulation. However, it must be said that if the personnel performing this procedure have sufficient skills and the patient himself follows the rules of preparing for the puncture and following a gentle regimen after it, then usually the lumbar puncture takes place quite quickly, with less pain. And the consequences of puncture on meningitis with such correct behavior of the patient and medical staff are either absent or minimal.

General information

Meningitis is a fairly serious disease that can lead to subsequent irreversible changes, disability and even death. The basis of this disease is inflammation of the membranes of the brain, as well as the spinal cord. During the inflammatory process, the production of excess cerebrospinal fluid is triggered, with damage to the brain matter, as well as a decrease in blood circulation in the microvascular bed. All this can lead to a serious complication - cerebral edema, which is already an emergency condition and requires intensive measures. In addition, meningitis is accompanied by neurological disorders, which can subsequently seriously affect a person’s future life.

If meningitis is suspected, the patient should be hospitalized as soon as possible

Meningitis itself may have various factors that trigger its development. Usually there are purulent and aseptic varieties. The purulent form of meningitis appears due to the action of bacteria (pneumococci, meningococci and Staphylococcus aureus, as a consequence of surgical interventions). The aseptic type of meningitis is caused by viruses. Aseptic meningitis can be triggered by the action of herpes viruses, enteroviruses, and choriomeningitis viruses.

Such features require specific treatment, since the therapy for bacterial or viral meningitis is different. But in order to determine the treatment method and the causative agent, a special microbiological study of the cerebrospinal fluid is necessary, which is what a lumbar puncture allows.

The puncture mechanism itself is based on the following principle. Cerebrospinal fluid (or cerebrospinal fluid) is formed in special areas of the brain - the ventricles. It is produced choroid plexuses, which are located at the bottom of the ventricles. After this, the cerebrospinal fluid circulates through the ventricular system and exits into the subarachnoid space of the spinal cord and brain. Functions cerebrospinal fluid are that it maintains constant levels of intracranial pressure, absorbs head impacts, and also performs various trophic (nutritional) functions for brain tissue. Since the cerebrospinal fluid also washes the membranes, it is a kind of reservoir for bacteria and viruses during meningitis.

Taking cerebrospinal fluid for examination

Therefore, a lumbar puncture, which allows penetration into the subarachnoid space, makes it possible to take samples of cerebrospinal fluid and examine them for the presence of an infectious or viral agent.

Indications for manipulation

Lumbar puncture should be performed in the following situations:

Suspicion of a neuroinfection. A striking example These diseases are precisely meningitis. It can also be encephalitis,
Suspicion of hemorrhage in the subarachnoid space.
The need to confirm or exclude oncological and metastatic processes in the structures of the brain (meninges).
Diagnosis of conditions such as liquorrhea.
The need to diagnose liquor fistulas. In this case, the introduction of a special x-ray is also added to the lumbar puncture contrast agent.
Prevention and exclusion of neuroleukemia in hematological oncology patients.

These indications are called absolute, that is, those in which a puncture is necessary and is key. There are also relative indications - those in which lumbar puncture is either not a fundamental or an additional method. Usually this:

Various processes accompanied by demyelinating processes.
Inflammatory polyneuropathy.
Unexplained fever.

Contraindications

There are a number of contraindications to performing a lumbar puncture

However, in addition to the indications for puncture, there are also conditions whose presence requires abandoning this manipulation.

Brain swelling. At this state A lumbar puncture will lead to changes in intracranial pressure, which in turn can lead to herniation of the cerebellum into the foramen magnum and death. This is the most important and first contraindication to lumbar puncture.
Any large-scale processes in the structures of the brain.
Conditions with low blood clotting ability.
Inflammatory conditions at the puncture site.

Methodology

Lumbar puncture is performed in the following way. patient on operating table They are asked to take a characteristic position: lying on their side, their knees should be brought to their chest, and their head should be tilted forward. This position is necessary to widen the intervertebral spaces, which provides the doctor performing the procedure with greater comfort. The puncture can also be performed while sitting (especially in obese patients).

The puncture site itself is at level 3-4 lumbar vertebra. A convenient guide for identifying the 4th vertebra is a line that can be visually drawn connecting the ridges iliac bones. The skin at the site of manipulation is treated with some kind of antiseptic, and then local anesthesia is started. For this, an anesthetic is used, which is administered in 3 ways sequentially: intradermal, subcutaneous and during the puncture. A needle with a mandrel is inserted parallel to the spinous processes and carefully moved forward until a feeling of failure is felt, which will mean that the needle has passed through the ligaments and hard shell, after which a test sample of liquor fluid is taken in order to confirm the correct placement of the needle. After that, a clean test tube is inserted into which the liquid is collected.

The appearance and color of the liquid, as well as the nature of its flow into the test tube, are carefully assessed.

If the liquid does not come in the form of rare drops, but often and quickly, this indicates a possible intracranial hypertension. It is also necessary to check for the presence of red coloration of the liquid, which may indicate injury to the vessel during manipulation or hemorrhage into the subarachnoid space.

Consequences

Only a specially trained doctor with the necessary tools can take a puncture correctly.

As mentioned above, if the patient correctly follows all the recommendations prescribed to him and the medical staff is competent, complications after the puncture are minimal. However, there are still some situations that can appear even with competent manipulation. They make up a small percentage in the overall summary of all cases, but you should not forget about them:

Herniation of brain structures or dislocation of midline structures.
Pain syndrome due to damage to nerve roots.
Headache.
Hematomas developing as a result of injury small vessels along the puncture needle.

Also, a separate group of complications are complications of puncture when performed in pregnant women. Such patients, especially in the first trimester, may be at risk for miscarriages in response to puncture.

Patients with heart disease and a spinal puncture require close attention, since when vasovagal reactions are triggered, the consequences can be catastrophic, as breathing or cardiac activity may stop.

Features of cerebrospinal fluid in meningitis

Each meningitis is determined by the type of its pathogen, resulting in changes in the cerebrospinal fluid for each of them.

Therefore, knowing certain visual features of cerebrospinal fluid and its microbiological characteristics, you can carry out the correct differential diagnosis types of meningitis and begin the right treatment.

CSF examination confirms the diagnosis of meningitis

The bacterial type of meningitis is characterized by next view cerebrospinal fluid:

Opaque color of the liquor.
The predominance of the percentage of leukocytes over lymphocytes.
The number of neutrophils and segmented cells is over 1000 per 1 cubic millimeter.
Presence of a positive bacterial culture.
Low glucose levels.

Aseptic or viral meningitis characterized by the following liquor:

Clear-looking liquor.
The predominance of the percentage of lymphocytes over leukocytes.
No inoculated bacterial culture.

Individual diagnostic features cerebrospinal fluid has tuberculous meningitis:

Opalescent, cloudy appearance of cerebrospinal fluid in a test tube.
The number of lymphocytes is over 100 per cubic millimeter.
Low glucose levels.
Bacteria that can be identified by staining.

Microbiological examination of cerebrospinal fluid

Such features of tuberculous meningitis indicate that it is impossible to make a correct diagnosis only based on visual data of the cerebrospinal fluid, since without knowing microbiological research, you can make a diagnostic error.

Confirmation of the diagnosis is always based on a combination of the visual qualities of the cerebrospinal fluid and its microbiological properties.

Treatment control

Approximately by the third week of treatment, it is necessary to assess how meningitis regresses under the influence of drugs. To do this, repeat puncture is used. It is used to analyze changes in cellular composition, as well as the absence of a bacterial culture in the cerebrospinal fluid, which serves as a sign of clinical recovery.

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How to perform a puncture for meningitis

Meningitis is an infectious disease. Inflammatory processes in the membranes of the brain develop due to the ingress of harmful microbes. Any microorganism can cause meningitis. Modern infectious disease specialists came to this conclusion during research. The disease affects people at any age.

Meningitis is completely different in its development and causes of formation. Often the disease can recur for several years. Sometimes a person may get hurt once, but very seriously. The pathological condition is a direct threat to life and is fraught with serious complications. Provoking factors may be purulent otitis media or sinusitis.

Often, a traumatic brain injury causes inflammation of the membranes of the brain and the patient’s well-being thereby worsens significantly. In most cases, the disease is characterized by formation due to infection by harmful microorganisms through entry through the bloodstream. There is a certain predisposition to the development of the disease at the level of immunity. Often entire families and generations suffer from meningitis.

Scientists have not yet identified a reliable effect of immunity on meningitis. However, the fact that boys get sick 4 times more often than girls has been proven based on statistical studies. The course of the disease can be influenced by viruses, bacteria and fungi. IN last years Cases of tuberculous meningitis are increasingly being identified. A particularly dangerous condition causing complex purulent processes.

It is important to remember that young children are especially hard hit by meningitis. Moreover, the typical situation of development of the main symptoms is similar at any age:

The appearance of severe headaches, along with vomiting and nausea against the background of measles, rubella, chickenpox, mumps, etc.
A significant increase in temperature combined with pain in the neck and back, which intensifies when bending or turning the head.
The patient may be unconscious, experience convulsions, drowsiness, nausea, and vomiting.
Damage to the skin with a rash of any nature with high fever.
Infants cry monotonously, febrile state and the fontanelle swells.

The above symptoms are not a reliable basis for confirming or refuting the diagnosis. Correct diagnosis carried out in a medical clinic.

Typical symptoms of meningitis, with varying degrees of probability, require appropriate treatment with an exclusively individual approach to each patient. It is possible to confirm or refute the diagnosis only with the help of a spinal puncture.

Spinal cord puncture, indications for performance

To diagnose meningitis, a spinal cord puncture is performed, which in medicine is called a lumbar puncture. The essence of the technique is to insert a special needle into the area between the 3rd and 4th lumbar vertebrae. The liquid is examined for the content of proteins, glucose and other specific components.

Correct techniques when preparing and performing a puncture allow the procedure to be completed quickly and with minimal pain for the patient. A puncture for meningitis will not have negative consequences, If medical staff has sufficient experience in carrying out this diagnosis.

Compliance with all prescriptions and correct behavior after puncture is important for the patient himself. Irreversible changes in the body that result from untimely treatment can cause disability and even fatal outcome. In addition to cerebral edema, complex neurological disorders, which is not the most in the best possible way affects a person's life.

It is not recommended to refuse a puncture for meningitis. It is not only the only way to determine inflammation in the spinal cord, but also allows you to identify which microorganisms provoked the disease. This plays a significant role in choosing the most appropriate treatment methods.

Microbiological examination of cerebrospinal fluid to identify the pathogen is possible only through lumbar puncture. During circulation, cerebrospinal fluid from the ventricles enters the space of the brain and spinal cord. An excess of this fluid characterizes meningitis.

Lumbar puncture is performed based on the following situations:

with the probable presence of a neuroinfection;
for diagnosing oncological diseases;
to detect liquorrhea;
in order to exclude hemorrhage into the subarachnoid space.

Possible risks and contraindications

A prerequisite for puncture is the absence of contraindications. This applies to complex conditions of the patient’s body, which can provoke a deterioration in well-being. These include:

structural lesions of the brain of volumetric flow;
cerebral edema;
poor blood clotting;
pathological disorders in the back area where the procedure should be performed.

Puncture for meningitis takes place in operating conditions. Lying on your side, with your legs pressed to your chest and your head down, allows for optimal expansion of the intervertebral spaces. The doctor will be able to perform all manipulations with maximum precision. Fat people The puncture is performed in a sitting position.

Certain anesthetics are used for pain relief. They are introduced into the puncture site in three stages. At the same time, a needle must be inserted to withdraw the test fluid. The rapid flow of fluid into the test tube indicates the presence of intracranial hypertension. If there is an admixture of blood in it, then there may be hemorrhage into the subarachnoid space.

Injury to blood vessels during puncture for meningitis can lead to the obtained fluid turning reddish. An important nuance is that it is necessary to carry out preliminary collection of the test liquid. All manipulations must be carried out quickly and accurately in order to avoid possible trauma to the ligaments and membranes of the spinal sections.

Puncture in children

There is no place for self-medication in the treatment of meningitis in children. Postponing a visit to the doctor even for hours is dangerous due to possible unpredictable consequences. According to statistics, despite technological progress in medicine, mortality from meningitis has not decreased over the past 50 years.

The incubation period for meningitis in children lasts about 10 days. Bacterial meningitis is especially severe before the age of 6 months. It often causes quite dangerous complications. The clinical picture of development is similar to the symptoms of the disease in adults. The first signs begin to appear suddenly.

Children aged 2 to 10 years are initially bothered by a fever, gradually turning into a drowsy state. In newborns, the fontanelle thickens. Kids become capricious and irritable. Older children, from 7 to 12 years old, may be unconscious with meningitis. This manifestation may include severe headaches, a sudden increase in blood pressure and the development of a rash on the skin.

Of primary importance in full examination has a puncture for meningitis in children. The procedure is performed under sterile conditions by inserting a needle into the lower back. The specifics of the puncture are absolutely identical to performing such a mini-operation on an adult.

Each child requires more thorough examination before carrying out such diagnostics. There are more contraindications due to a fragile growing body than in an adult. In addition to puncture for meningitis, blood tests must be performed. Computed tomography and electroencephalography are almost always prescribed. Comprehensive examination allows you to make an accurate diagnosis and, based on the specifics of the disease, begin adequate treatment.

After a puncture for meningitis, the child is given complete bed rest for up to three days. It all depends on the individual reaction to synthetic drugs used for pain relief. At first you need to lie only on your stomach to avoid pressure on the puncture site.

It is recommended to drink plenty of fluids, neither cold nor hot. The child should be in a room where there are no strangers and preferably under the constant supervision of adults. Sometimes intravenous plasma substitutes are prescribed.

If, after a puncture for meningitis, a child begins to complain of chills, discomfort in the neck, or a feeling of tightness, you should immediately consult a doctor. This also applies to any discharge or numbness at the puncture site.

Consequences

Relief of the disease in children by early stages allows you to successfully restore health in short period time. After an appropriate period of treatment, children can lead a normal lifestyle. Timely seeking help from a doctor does not have undesirable consequences. The child’s body recovers after just a short rehabilitation.

Puncture for meningitis in children provokes the most minimal consequences. There is no pain during the procedure. This is all thanks to unique thin needles designed for such procedures. Gradual anesthesia with triple injection of anesthetic plays an important role here.

Very rarely, as a result of incorrect manipulations or insufficient qualifications of the doctor, a puncture for meningitis can provoke undesirable consequences:

Hemorrhagic complications. These consequences include internal traumatic brain injuries, which manifest themselves as hematomas. Violations of diagnostic technique during puncture can damage blood vessels and provoke bleeding.
Postpuncture syndrome. Intracranial vessels are displaced and dilated when epithelial cells enter the spinal cord.
Teratogenic factor, characterized by the formation of epidermoid tumors. IN spinal canal elements of the skin enter, and as a result, neoplasms develop. The lower back, legs, and lower back begin to hurt more and more often over time.
Direct trauma, this condition is determined by damage nerve endings when manipulating the needle. The lesion may affect the intervertebral discs. Various infections and even another type of meningitis develop.
Liquorodynamic complications represent the occurrence of acute pain syndrome against the background of an existing tumor.
Changes in the liquor composition are observed when air enters when inserting a needle, chemical substances, microparticles from anesthetics and more.
Other complications occur after a violation of the puncture technique. This is the development of radiculitis, myelitis or arachnoid. Dizziness, vomiting, and nausea may occur in the first hours after the puncture. However, they are not dangerous and pass quickly.

A puncture for meningitis is performed to extract and subsequently study the cerebrospinal fluid. Currently, this is the only possible method for correctly diagnosing dangerous disease. Doctors identify the normality or pathology of the fluid when it is directly removed.

The effectiveness of the procedure for meningitis is often influenced by extraneous factors. These include obesity, dehydration, back surgery, and more. Sometimes the lumbar puncture needs to be repeated again, with a more thorough step-by-step diagnosis.

The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action. Do not self-medicate. Consult your healthcare provider.

Indications for puncture for meningitis

As practice shows, puncture for meningitis, when inflammatory process affects the spinal cord and brain, is prescribed to patients in almost all cases. Identify the pathogen pathological process without resorting to similar procedure, the doctor will only be able to do so when a characteristic rash appears on the patient’s skin.

Essence of the procedure

Spinal cord puncture for meningitis is the only way to absolutely accurately determine the nature of the pathological process, which can be viral or bacterial in nature, and based on the results, choose the most effective scheme therapy. In the first case we are talking about serous meningitis. If the disease is of a bacterial nature, then they talk about the development of cerebrospinal meningitis, which is more common in children.

In the opinion of the vast majority of patients, lumbar puncture is very dangerous and painful procedure. However, in practice this is not always and not entirely true. Provided that the medical personnel performing such a manipulation are sufficiently qualified, and the patient follows all recommendations regarding preparation for the procedure, the process itself does not take very much time, and the patient experiences minimal painful sensations. In this way, it is possible to avoid or minimize the consequences of the manipulations performed.

However, taking a sample of cerebrospinal fluid has not only a diagnostic purpose, but also helps to reduce high intracranial pressure, which is the cause of painful headaches.

As for small patients, for meningitis in children, staging accurate diagnosis And timely therapy can save lives. It is also necessary and very important for children to have a puncture.

However, before a child is subjected to such manipulation, he must be carefully examined. This is due to the fact that young patients have much more contraindications than adults, since their body is not yet strong enough and continues to grow. After the child has a puncture, he must be provided with bed rest for 3 days.

Puncture technique

The mechanism of puncture is based on the following principle. Cerebrospinal fluid is formed in special areas of the brain. The choroid plexuses, which are localized at the bottom of the ventricles, are responsible for its production. After this, the fluid begins to circulate through the ventricular system and ends up in the subarachnoid space of the brain and spinal cord. In turn, cerebrospinal fluid is responsible for maintaining a constant level of intracranial pressure, serves as a kind of shock absorber in the event of a head impact, and also nourishes brain tissue. Since this fluid also washes the meninges, it is a reservoir for viruses and bacteria in the event of meningitis.

A spinal tap is performed as follows. The patient lies down on the operating table and takes the appropriate position, i.e. lies on his side, bringing his knees to his chest and tilting his head forward. This position is necessary in order to achieve widening of the spaces between the vertebrae, which will create convenience for the doctor who will perform the puncture. The procedure can also be performed in a sitting position, especially when it comes to obese patients.

The skin in the area where the needle will be inserted is treated with an antiseptic, after which local anesthesia is given. To do this, the anesthetic is administered intradermally, subcutaneously and during the procedure. After this, a puncture is made at the appropriate level of the lumbar vertebrae with a needle, which is inserted until a feeling of failure occurs. Only after this is a test sample of cerebrospinal fluid performed, which is necessary to confirm the adequate location of the inserted needle. After the test collection, a clean test tube is placed into which the liquid is collected.

Frequent and rapid flow of cerebrospinal fluid is a possible sign of increased intracranial pressure. At the same time, the doctor should pay attention to the red tint of the resulting composition. This may be a sign of a vessel injured during the procedure or hemorrhage into the subarachnoid space.

As for children, if chills or discomfort in the cervical region, as well as feelings of tightness after little patient They took cerebrospinal fluid, the situation requires immediate contact with your doctor. The same should be done by parents of those children who have any discharge or a feeling of numbness in the puncture area on the back.

Existing indications and contraindications for the procedure

Doctors perform a lumbar puncture under the following circumstances:

In case of suspected neuroinfection. A striking example of such an infection is cerebrospinal meningitis. In some cases, it may also be encephalitis.
If there is a suspicion of hemorrhage in the subarachnoid space.
If there is a need to confirm or exclude oncological diseases and the presence of metastases in brain tissue.
When is it necessary to diagnose liquorrhea?
To prevent and exclude neuroleukemia in cancer patients.

The listed indications are considered absolute for carrying out the indicated manipulation. In medical practice, there are also relative indications when lumbar puncture is an additional diagnostic method. These include:

unexplained fever;
inflammatory polyneuropathy;
conditions accompanied by demyenilizing processes.

It is impossible to take cerebrospinal fluid in a situation where:

Swelling of the brain developed. The procedure is fraught with death for the patient.
The development of volumetric processes in brain tissues is underway.
The patient has low blood clotting.
An inflammatory process developed in the area of the procedure.

Possible complications

Complications from manipulations with the collection of cerebrospinal fluid to diagnose a patient’s condition with meningitis can occur only in a situation where the rules of the procedure were violated or the qualifications of medical workers were not high enough.

Nevertheless, there are cases when even a competently performed procedure has undesirable consequences. Their share in medical practice is not so high, but you should still not forget about them:

the procedure performed may have a negative impact and lead to wedging of brain structures or changes in the position of central structures;
develops pain syndrome due to damage to nerve roots;
headaches occur;
hematomas appear.

A separate group includes complications that appear after the procedure in pregnant women. It is worth remembering that manipulation, especially during the first trimester of pregnancy, can result in a miscarriage for the expectant mother.

Patients suffering from cardiological pathologies. For such patients, a puncture may result in respiratory arrest or cardiac arrest.

Finally, repeating the procedure in the future can lead to the formation of so-called implantation cholesteatomas in the spinal canal. But such a complication is not so terrible in comparison with the death resulting from the development of meningitis.

There is a widespread belief among patients that the manipulation performed can lead to the development of paralysis. However, the probability similar complication very small and amounts to approximately 1%.

After a 2 week course intensive care an assessment of the patient's health status is carried out, for which it is done repeated puncture. The results of cerebrospinal fluid studies allow us to judge the patient’s recovery.

Meningitis is a serious and very dangerous disease, to eliminate which it is necessary to accurately determine the catalyst of the infection. And only possible method The study in this case is a lumbar puncture. This is the only way the patient can avoid death and hope for recovery. A existing risks Compared to the possibilities provided by the procedure, they are negligible.

Meningitis

A.Etiology. Meningitis is a complication of bacteremia. In children over 2 years of age, the causative agents of acute bacterial meningitis are most often Haemophilus influenzae type B (60-65%), meningococci and pneumococci. Less common are streptococci, Staphylococcus aureus, and gram-negative enterobacteria. With the introduction of vaccination against Haemophilus influenzae type B, the incidence of meningitis caused by this organism has decreased sharply.

b.Survey

1) U infants the first manifestations of meningitis are nonspecific - severe crying, irritability, anorexia, vomiting, drowsiness, bulging fontanelles. Meningeal symptoms are rare and there may be no fever. Particular attention is paid to disturbances of consciousness. One of the first symptoms of meningitis may be seizures, so in combination with fever they are an indication for CSF examination.

2) In children over 1 year of age meningeal symptoms with meningitis they are more common. The indication for lumbar puncture is Brudzinski's symptom (when the neck is flexed while lying on the back, involuntary flexion of the legs in the hip joints is observed).

3) Meningitis must be excluded in case of bacteremia.

4) If meningitis is suspected, a lumbar puncture is performed. Plasma glucose is preliminarily determined for comparison with the glucose level in the CSF.

5) A relative contraindication to lumbar puncture is papilledema. Before performing a puncture, a consultation with a neurosurgeon is necessary. This symptom is not typical for acute bacterial meningitis, so other diseases, such as a brain abscess, should be excluded.

6) Conduct tuberculin test, culture of blood, feces, urine, joint fluid, abscess contents, discharge from the middle ear, etc.; bacterioscopy of smears and culture from all foci of infection. The levels of BUN, electrolytes and osmolarity of plasma and urine are determined, and a chest x-ray is performed. For infants, head circumference is measured.

V.Diagnosis meningitis is diagnosed only on the basis of the results of a lumbar puncture.

1) In bacterial meningitis, the CSF is turbid, its pressure is increased, the number of leukocytes is more than 100 μl -1, neutrophils predominate, the protein level is increased, the glucose level is less than half its level in plasma. Bacterioscopy of a Gram-stained CSF smear reveals the pathogen. All of these signs are not always present, therefore, with any of them, especially if neutrophils predominate in the CSF, meningitis should be suspected. CSF culture is indicated to confirm the diagnosis.

2) Determination of capsular polysaccharide antigens allows you to quickly identify the pathogen in some bacterial meningitis.

G.Treatment. Immediately after taking material for culture, IV antibiotics are prescribed. The choice of antibiotic is determined by the results of bacterioscopy of Gram-stained CSF smears and the age of the child. If gram-negative bacilli are detected, children over 2 months of age are prescribed dexamethasone, as it prevents hearing loss due to meningitis caused by Haemophilus influenzae type B.

1) If in children older than 2 months there is no reason to suspect a rare pathogen, choose any of two treatment regimens: ampicillin (300-400 mg/kg/day IV, the dose is divided and administered every 6 hours) in combination with chloramphenicol (100 mg/kg /day intravenously, the dose is divided and administered every 6 hours); or cefotaxime (150 mg/kg/day IV, divided dose and administered every 8 hours) or ceftriaxone (75-100 mg/kg/day IV, divided dose and administered every 12-24 hours). If the pathogen is Haemophilus influenzae, sensitive in vitro to ampicillin, ampicillin is additionally prescribed. For meningitis caused by Pseudomonas aeruginosa, the drug of choice is ceftazidime. For meningococcal or pneumococcal meningitis, the drug of choice is benzylpenicillin, and third-generation cephalosporins are used as a reserve drug. We prefer the combination of ampicillin with chloramphenicol because it is the most effective and safe.

2) The duration of treatment is determined individually. Standard courses of antibiotic therapy: meningitis caused by Haemophilus influenzae - 7-10 days, meningitis caused by meningococci - 5-7 days, meningitis caused by pneumococci - 10-14 days.

3) Dexamethasone, 0.6 mg/kg/day IV (dose divided and administered every 6 hours), is prescribed during the first 4 days of antimicrobial therapy. The drug is administered simultaneously with the antibiotic or immediately after it.

4) It is necessary to identify in time arterial hypotension, bleeding and ADH hypersecretion syndrome. The latter occurs in the first 72 hours of treatment, and until it is eliminated, fluid intake is limited to 3/4 of the minimum water requirement. At the same time, in most cases, patients with meningitis are admitted to the hospital 12-24 hours after the onset of the disease, when they are already developing dehydration. Therefore, before limiting fluid intake, it is necessary to restore BCC. Maintaining normal blood pressure and blood supply to the brain is more important than preventing ADH hypersecretion syndrome.

5) During the treatment period, monitor heart rate, blood pressure, respiratory rate and body temperature. Conducted daily neurological examination and diaphanoscopy (with an open fontanel), measure the head circumference.

6) At severe course or if therapy is unsuccessful, lumbar puncture is repeated every 24-48 hours. An indicator of the effectiveness of treatment is the disappearance of the pathogen from the CSF 24-48 hours after the start of therapy.

7) Persistence of fever is most often due to phlebitis, drug reaction, hospital-acquired infection, concomitant viral infection, or subdural effusion. The latter occurs in the acute period of the disease in 50% of children and is often asymptomatic. Prolonged (more than 7 days) or recurrent fever is an indication for lumbar puncture. In this case, it is necessary to exclude foci of infection in the subdural space, bones, joints, pericardium and pleural cavity. In some cases, CT is indicated to confirm subdural effusion.

8) At the end of antimicrobial therapy, we do not repeat the lumbar puncture because recurrence of bacterial meningitis after stopping antibiotics is rare. For uncomplicated meningitis, at the final stage of treatment, you can switch to intramuscular administration (ceftriaxone, 50-75 mg/kg intramuscularly 1 time per day) or oral administration (chloramphenicol in the same doses as for intravenous administration). In the latter case, monitor the level of the drug in the blood.

9) Persons who have close contact at home or in day care with a patient with meningitis caused by Haemophilus influenzae type B or Neisseria meningitidis are advised to be tested and preventive treatment. If the causative agent is Haemophilus influenzae type B, the risk of meningitis for family members under 6 years of age is 0.5%, if the causative agent is Neisseria meningitidis, the risk for all ages is 0.5%.

10) All children with Haemophilus influenzae type B infections are recommended to be treated with rifampicin to eliminate nasopharyngeal carriage. The drug is prescribed at a dose of 20 mg/kg (maximum 600 mg) once a day for 4 days (Red Book, American Academy of Pediatrics, 1991).

J. Gref (ed.) "Pediatrics", Moscow, "Practice", 1997

Puncture of cerebrospinal fluid into medical terminology is designated as a lumbar puncture, and the fluid itself is called cerebrospinal fluid. Lumbar puncture is one of the most complex methods that has diagnostic, anesthetic and medicinal purposes. The procedure involves inserting a special sterile needle (length up to 6 cm) between the 3rd and 4th vertebrae under the arachnoid membrane of the spinal cord, and the brain itself is not affected at all, and then extracting a certain dose of cerebrospinal fluid. It is this liquid that allows you to obtain accurate and useful information. In laboratory conditions, it is examined for the content of cells and various microorganisms to identify proteins, various types of infections, and glucose. The doctor also evaluates the transparency of the cerebrospinal fluid.

A spinal tap is most often used when central nervous system infections such as meningitis and encephalitis are suspected. Multiple sclerosis is very difficult to diagnose, so a lumbar puncture is indispensable. As a result of the puncture, the cerebrospinal fluid is examined for the presence of antibodies. If antibodies are present in the body, the diagnosis is multiple sclerosis practically installed. The puncture is used to differentiate a stroke and identify the nature of its occurrence. The cerebrospinal fluid is collected into 3 test tubes, and later the blood mixture is compared.

With the use of lumbar puncture, diagnosis helps to detect inflammation of the brain, subarachnoid bleeding or detect herniated intervertebral discs by injecting a contrast agent, as well as measure the pressure of the spinal cord fluid. In addition to collecting liquid for research, specialists also pay attention to the flow rate, i.e. if one clear drop appears in one second, the patient has no problems in that area. IN medical practice spinal puncture, consequences which can sometimes be very serious, is prescribed in order to remove excess cerebrospinal fluid and thereby reduce intracranial pressure in benign hypertension, is carried out to administer medications for various diseases, for example, chronic normotensive hydrocephalus.

Contraindications to lumbar puncture

The use of lumbar puncture is contraindicated for injuries, diseases, formations and certain processes in the body:

Edema, space-occupying formations of the brain;
Intracranial hematoma;

Dropsy with extensive education in the temporal or frontal lobe;

Brain stem entrapment;

Bedsores of the lumbosacral area;

Heavy bleeding;

Skin and subcutaneous infections in the lumbar region;

Thrombocytopenia;

The patient's condition is extremely serious.

In any case, the doctor first conducts a series of tests to ensure that the prescription is urgently needed. spinal puncture. Consequences it, as already noted, can be very, very serious, since the procedure is risky, and it is associated with certain risks.

Spinal cord puncture and its consequences

The first few hours (2-3 hours) after the procedure should not get up under any circumstances, you must lie on a flat surface on your stomach (without a pillow), later you can lie on your side, for 3-5 days you should observe strict bed rest and do not take standing or sitting position to avoid various complications. Some patients after a lumbar puncture experience weakness, nausea, pain in the spine and headache. The doctor may prescribe medications (anti-inflammatory and painkillers) to relieve or reduce symptoms. Complications after lumbar puncture may occur due to incorrect procedure. Here is the list possible complications as a result of incorrect actions:

Trauma of varying degrees of complexity to the spinal nerve;
Various brain pathologies;

Formation of epidermoid tumors in the spinal canal;

Damage to intervertebral discs;

Increased intracranial pressure in oncology;

Infection.

If the procedure was performed qualified specialist, all necessary rules are strictly followed, and the patient follows the doctor’s recommendations, then its consequences are minimized. Contact our medical center, where only experienced doctors work, do not risk your health!

Spinal cord puncture (lumbar puncture) is a type of diagnosis that is quite complex. The procedure removes a small amount of cerebrospinal fluid or injects drugs and other substances into the lumbar spinal canal. In this process, the spinal cord is not directly affected. The risk that arises during puncture contributes to the rare use of the method exclusively in a hospital setting.

Purpose of a spinal tap

Spinal cord puncture is performed for:

Performing a spinal tap

collecting a small amount of cerebrospinal fluid (CSF). Subsequently, their histology is carried out; measuring the pressure of cerebrospinal fluid in the spinal canal; removing excess cerebrospinal fluid; introducing drugs into the spinal canal; facilitating difficult labor in order to prevent pain shock, as well as as anesthesia before surgery; determining the nature of a stroke; isolating tumor markers; performing cisternography and myelography.

Using a spinal tap, the following diseases are diagnosed:

bacterial, fungal and viral infections(meningitis, encephalitis, syphilis, arachnoiditis); subarachnoid bleeding (hemorrhages in the brain); malignant tumors of the brain and spinal cord; inflammatory conditions of the nervous system (Guillain-Barré syndrome, multiple sclerosis); autoimmune and dystrophic processes.

Often a spinal tap is equated with a bone marrow biopsy, but this statement is not entirely correct. During a biopsy, a tissue sample is taken for further research. Access to the bone marrow is achieved through a puncture of the sternum. This method allows you to identify bone marrow pathologies, some blood diseases (anemia, leukocytosis and others), as well as metastases in bone marrow. In some cases, a biopsy can be performed during the puncture process.

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Indications for spinal cord puncture

Spinal cord puncture is mandatory for infectious diseases, hemorrhages, and malignant neoplasms.

Inflammatory polyneuropathy

A puncture is taken in some cases for relative indications:

inflammatory polyneuropathy; fever of unknown pathogenesis; demyelinating diseases (multiple sclerosis); systemic connective tissue diseases.

Preparatory stage

Before the procedure, medical workers explain to the patient: why the puncture is being performed, how to behave during the manipulation, how to prepare for it, and possible risks and complications.

Spinal cord puncture requires the following preparation:

Registration of written consent for the manipulation. Submission of blood tests, which evaluate its coagulation, as well as the functioning of the kidneys and liver. Hydrocephalus and some other diseases require computed tomography and MRI of the brain. Collection of information on the history of the disease, recent and chronic pathological processes.

The specialist must be informed about the medications taken by the patient. medicines, especially those that thin the blood (Warfarin, Heparin), relieve pain, or have an anti-inflammatory effect (Aspirin, Ibuprofen). The doctor should be aware of any existing allergic reaction caused by local anesthetics, drugs for anesthesia, iodine-containing agents (Novocaine, Lidocaine, iodine, alcohol), as well as contrast agents.

It is necessary to stop taking blood thinning drugs, as well as analgesics and non-steroidal anti-inflammatory drugs in advance.

Before the procedure, water and food are not consumed for 12 hours.

Women must provide information about their suspected pregnancy. This information is necessary due to the expected x-ray examination during the procedure and the use of anesthetics, which may have undesirable effect for the unborn child.

Your doctor may prescribe a medication to take before the procedure.

The presence of a person who will be next to the patient is mandatory. A child is allowed to undergo a spinal puncture in the presence of his mother or father.

Technique of the procedure

A spinal cord puncture is performed in a hospital ward or treatment room. Before the procedure, the patient empties his bladder and changes into hospital clothes.

Spinal cord puncture

The patient lies on his side, bends his legs and presses them to his stomach. The neck should also be in a bent position, with the chin pressed to the chest. In some cases, spinal puncture is performed with the patient sitting. The back should be as motionless as possible.

The skin in the puncture area is cleaned of hair, disinfected and covered with a sterile napkin.

The specialist can use general anesthesia or use a local anesthetic. In some cases, a drug may be used with sedative effect. Also during the procedure, heartbeat, pulse and blood pressure are monitored.

The histological structure of the spinal cord provides for the safest needle insertion between the 3rd and 4th or 4th and 5th lumbar vertebrae. Fluoroscopy allows you to display a video image on a monitor and monitor the manipulation process.

Next, the specialist takes cerebrospinal fluid for further research, removes excess cerebrospinal fluid or injects necessary drug. Liquid is released without outside help and fills the test tube drop by drop. Next, the needle is removed and the skin is covered with a bandage.

CSF samples are sent for laboratory testing, where histology occurs directly.

Spinal cord cerebrospinal fluid

The doctor begins to draw conclusions on the nature of the fluid exit and its appearance. IN in good condition The cerebrospinal fluid is transparent and flows out one drop per second.

At the end of the procedure you must:

compliance bed rest for 3 to 5 days as recommended by a doctor; keeping the body in horizontal position at least three hours; avoidance of physical activity.

When the puncture site is very painful, you can resort to painkillers.

Risks

Adverse consequences after spinal cord puncture occur in 1–5 cases out of 1000. There is a risk of:

Intervertebral hernia

axial herniation; meningism (symptoms of meningitis occur in the absence of an inflammatory process); infectious diseases of the central nervous system; severe headache, nausea, vomiting, dizziness. The head may hurt for several days; damage to the roots of the spinal cord; bleeding; intervertebral hernia; epidermoid cyst; meningeal reaction.

If the consequences of the puncture are expressed in chills, numbness, fever, a feeling of tightness in the neck, or discharge at the puncture site, you should immediately consult a doctor.

There is an opinion that during a spinal tap the spinal cord can be damaged. It is erroneous, since the spinal cord is located higher than the lumbar spine, where the puncture is directly made.

Contraindications to spinal cord puncture

Spinal cord puncture, like many research methods, has contraindications. Puncture is prohibited in case of sharply increased intracranial pressure, dropsy or cerebral edema, or the presence of various formations in the brain.

It is not recommended to take a puncture for pustular rashes in lumbar region, pregnancy, impaired blood clotting, taking blood thinning drugs, rupture of brain or spinal cord aneurysms.

In each individual case, the doctor must analyze in detail the risk of the manipulation and its consequences for the life and health of the patient.

It is advisable to contact an experienced doctor who will not only explain in detail why it is necessary to perform a spinal cord puncture, but will also carry out the procedure with minimal risk to the patient’s health.

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Meningitis - acute infection, which is accompanied by inflammation of the meninges. Lumbar puncture for suspected meningitis is the main diagnostic method that allows you to reliably determine the presence of infection in the body. The manipulation involves inserting a needle into the subarachnoid space and taking a sample of cerebrospinal fluid. In this way, it is possible to establish the viral or bacterial nature of the infection, as well as to designate treatment tactics.

Meningitis is a dangerous disease that can cause serious consequences. The pathology is characterized by inflammation of the lining of the brain, in which a large amount of cerebrospinal fluid (CSF) begins to form and is damaged. medulla, blood microcirculation in the vascular bed deteriorates.

The consequences of such inflammation are neurological changes that negatively affect the life and health of the patient, as well as cerebral edema - emergency requiring immediate medical attention.

Factors causing development meningitis are divided into aseptic and purulent subtypes. The aseptic type is characterized viral nature infections: enterovirus, herpes and choriomeningitis viruses. The purulent type of infection is caused by the intervention of bacteria: meningococcal, pneumococcal, staphylococcal - or external surgical influence.

For meningitis, depending on the nature of the infection, it is necessary special treatment. To diagnose the causative agent of the disease and determine the method of therapy, specific research spinal cerebrospinal fluid - puncture for meningitis.

Excess cerebrospinal fluid (cerebrospinal fluid) is produced in the cerebral ventricles. At the bottom of these areas of the brain there are plexuses of blood vessels responsible for the production of fluid. The cerebrospinal fluid passes through the ventricles and penetrates the subarachnoid space of the brain and spinal cord. Liquor is necessary to maintain an optimal level of intracranial pressure, provide shock absorption during shock and injury, and nourish brain tissue and cells. The cerebrospinal fluid washes the lining of the brain and therefore represents a certain container for the accumulation of viruses and bacterial microorganisms in case of illness.

The introduction of a special needle into the subarachnoid space - lumbar puncture - is modern and precise method Diagnosis of the causative agent of infectious meningitis using spinal cord fluid analysis.

Features of the procedure

A puncture for meningitis is carried out as follows. The manipulation is carried out on the operating table, where the patient is positioned lying on his side with his legs pulled up to his chest. The head is tilted forward. The specific position of the body ensures the expansion of the intervertebral spaces, which facilitates the insertion of the needle and reduces the patient’s pain. In some cases, the procedure is performed while sitting (with overweight in the patient).

The target area from which material for analysis is taken is at the level of the 3rd – 4th lumbar vertebrae. To quickly and accurately determine the 4th vertebra, use next method: when connecting the iliac crests, a conditional line is drawn, which is located at the level of the desired vertebra.

The procedure is carried out under sterile conditions. The puncture site is treated disinfectant. After which the patient is injected with a drug for local anesthesia. The anesthetic is administered three times: intradermally, subcutaneously and additionally during manipulation.

The needle with the mandrel is inserted parallel to the spinous processes and slowly moved forward until it enters the cavity (feeling of failure). This means that the instrument has passed through the dura and ligaments and entered the subarachnoid space. An initial collection of cerebrospinal fluid is then performed to verify correct needle placement. After this, the material for research is collected into a clean test tube.

When assessing the result of the manipulation, the nature of the flow of cerebrospinal fluid into the test tube, the color and type of brain fluid are taken into account.

Normally, cerebrospinal fluid should flow out in the form of rare drops. With frequent and rapid flow, a significant increase in intracranial pressure is likely. The red tint of the secreted fluid indicates a possible hemorrhage in the subarachnoid space or damage to the vessel during puncture.

The duration of the procedure is about 7 – 10 minutes. In this case, the patient may experience quite unpleasant sensations. At the end of the manipulation, the needle is removed, the injection site is treated with an antiseptic and a bandage is applied. The patient must remain motionless for 2 to 3 hours after the puncture to eliminate the risk of cerebrospinal fluid leaking out of the hole.

A cerebrospinal fluid puncture can be taken not only to establish an accurate diagnosis and the causes of meningitis infection. The procedure is prescribed to eliminate intracranial hypertension through the direct administration of antibiotics. Also, during the manipulation, the pressure of the cerebrospinal fluid is measured and the patency of the cerebrospinal fluid tract is examined.

Analysis results

Each type of meningitis is characterized a certain type pathogen that will describe changes in the spinal fluid.

Viral meningitis is characterized by certain changes in the cerebrospinal fluid:

the predominance of the concentration of lymphocytes over the content of leukocytes in percentage terms;
absence of bacterial microorganisms in the sown material;
clear color of cerebrospinal fluid.

Bacterial meningitis is accompanied by the following changes in the cerebrospinal fluid:

increase in the number of neutrophils (above 1000 per 1 mm3);
the predominance of the concentration of leukocytes over the number of lymphocytes in percentage terms;
opaque color of cerebrospinal fluid;
low glucose levels;
the presence of a bacterial focus of infection;
positive reaction on Gram stain.

In typical types of the disease, the level of neutrophils reaches 75–95%. The leukocyte norm for newborns is up to 30/mm3. At an older age, the concentration should not exceed 5 leukocytes per 1 mm3. In healthy children who do not suffer from viral or bacterial meningitis, monocytes and lymphocytes predominate in the cerebrospinal fluid.

Tuberculous meningitis is characterized by specific symptoms:

the lymphocyte content reaches 100/mm3;
low glucose;
bacterial foci determined by staining of the cerebrospinal fluid;
cloudy liquid.

Indications and contraindications for the procedure

Lumbar puncture is prescribed in the following cases:

signs of neuroinfection (encephalitis, meningitis and others);
risk of hemorrhage in the subarachnoid space;
clarification of the diagnosis of liquorrhea;
diagnostics oncological processes and metastasis in the lining of the brain;
diagnosis of cerebrospinal fluid fistulas using cerebrospinal fluid puncture and injection of contrast agent;
diagnosis and prevention of neuroleukemia in patients with hematological oncology.

If there are such indications, taking a puncture of liquor fluid is the only and key diagnostic method. In some cases, the procedure is used as additional method examinations:

diseases accompanied by destruction of the membrane of neurons of the central nervous system and PNS (demyelinating processes);
inflammatory polyneuropathy;
attacks of fever in the absence of other symptoms.

Contraindications for puncture

Pathological processes in the structural elements of the brain.
Inflammatory lesions at the site of manipulation.
Brain swelling. If you take a puncture in this condition, then a sharp drop in intracranial pressure is possible, which can provoke wedging of the cerebellum into the foramen magnum. This process is fatal.
Blood clotting disorder.

Risks and consequences of a spinal tap

Complications after puncture occur primarily when the rules of manipulation are not followed and doctors make mistakes. In other cases, the following consequences may occur:

wedging of individual structural elements brain;
dislocation of midbrain structures;
damage to nerve endings causing pain in the patient;
headaches, nausea, vomiting;
hematomas at the site of needle insertion when small capillaries are damaged.

When taking cerebrospinal fluid material from pregnant women, the risk of spontaneous abortion increases, especially in the first third. Patients suffering from cardiovascular diseases also represent a risk group during manipulation. In particularly serious cases, the launch of vasovagal processes can provoke cardiac and respiratory arrest.

Contrary to popular belief that puncture can lead to paralysis, this complication unlikely. The needle is inserted into the part of the spine that is most poorly innervated and the risk of damage to nerve endings is very low. The incidence of complications after puncture in patients does not exceed 1%.

After two weeks of intensive treatment, the patient’s health condition and the effectiveness of the chosen therapy method are assessed. To do this, repeat manipulation is performed with the collection of spinal fluid material for research. Based on the results of the puncture, changes in cellular composition, determine the presence or absence of a bacterial culture in the contents. Positive dynamics indicate the patient’s clinical recovery.

Meningitis is a serious disease that requires accurate identification of the causative agent of the infection and the appointment of competent treatment. Cerebrospinal fluid puncture is the only and reliable method for diagnosing the disease.