II.5.2.2) COMPLICATIONS OF LUMBAR PUNCTURE
As in any other procedure, there might be complications after,
and in lumbar puncture some complications have being observed such as;
1. Postural puncture headache (PDPH): It is usually
self-limiting, but when serious, supportive treatment for the PDPH and its
accompanying symptoms include: bed rest, analgesics, hydration,
corticosteroids, and anti-emetic medications [43]. Also in
case of severe and persistent headaches, injecting saline into the epidural
space may be therapeutic [43].
2. Local back pain [43]
3. Infection[43]
4. Spinal hematoma[43]
5. Subarachnoid epidermal cyst[43]
6. Apnea[43]
7. Herniation (post procedural cerebral herniation):
Herniation can be the direct cause of death in around 30% of such children.
Therefore, it is practical to perform cranial CT imaging to evaluate any such
abnormalities before performing an LP [41][ 43].
8. Transient limp or paresthesia[43]
9. Transient ocular palsy[43]
10. Cerebral Herniation[43]
II.5.3) OTHER LABORATORY INVESTIGATIONS
Despite the fact that CSF analysis from lumbar
puncture is the gold standard in the diagnosis of meningitis , some other tests
could be performed like the following:
? C-REACTIVE PROTEIN (CRP) :
Clinically it is not easy to differentiate between bacterial and viral
etiologies in patients with suspected meningitis, and due to the high mortality
rate and potential neurological sequelae in survivors, there is an urgent need
for rapid diagnosis with a near 100 % sensitivity. CRP was used and is still
used as the biomarker for inflammation and tends to be elevated in both viral
and bacterial infections, limiting its ability to discriminate between
bacterial and viral etiologies of meningitis [44].
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? PROCALCITONIN :Procalcitonin (PCT) is now
considered to be the best candidate to replace CRP due to its high diagnostic
accuracy in various infectious pathologies, including sepsis, acute infections,
endocarditis, and pancreatitis. Normal PCT levels of healthy individuals are
less than 0.1ng/ml and level increase drastically in response to bacterial
infections, unlike CRP, PCT has not been reported to the elevated in viral
infections, thus conferring it to the important ability to distinguish easily
between bacterial and viral etiologies [44].
- PCT also shows utility in the early diagnosis of meningitis
by rising after 4h, peaking at 6h and remaining elevated over 24 h. This is in
contrast to CRP, which rises over 6-12h and peaks at 24 -48 h. This delay in
diagnosis combined with the traditional 72h wait for results of Gram stains,
often results in patients receiving empiric antibiotics
[44].
? Full blood count, Serum electrolytes and Coagulation
studies: Normally these investigations are required initially before
thinking about lumbar puncture, in order to assess for sepsis complications
[21].
? Serum Glucose: This test must be measured
routinely in a child having meningitis, since in a state of hypoglycaemia (low
glucose in blood) seizure might occur and it can be the cause of convulsion in
children apart from the presence of uncontrolled fever
[21].
? Blood Cultures: Cultures are also important
in the diagnosis of the disease especially in those patients having
contraindications towards lumbar puncture [21].
? Normally all the above usually changes in a
declining pattern after the introduction of antibiotics , but some authors
propose Latex agglutination , as a reliable test to detect bacterial capsular
antigens in patients with suspected bacterial meningitis and have been
receiving antibiotics all the time lumbar puncture was performed and it is also
estimated that in the future a more sensitive technique like 16rRNA gene by
polymerase chain reaction might help in the diagnosis of bacterial meningitis
in patients already on antibiotics[23].
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