What are the indications for lumbar puncture (LP) in an adult with muscle fasciculations, a symptom of potential neurological disorders?

From the Guidelines

Lumbar puncture (LP) is indicated in adults with muscle fasciculations when there is a suspicion of neurological disorders such as Guillain-Barré syndrome, multiple sclerosis, or spinal cord compression.

Indications for LP

• Diagnosis of neurological disorders, such as Guillain-Barré syndrome, multiple sclerosis, or spinal cord compression
• Investigation of suspected central nervous system infections, such as meningitis or encephalitis
• Evaluation of cerebrospinal fluid (CSF) biomarkers for neurodegenerative diseases, such as Alzheimer's disease

Contraindications for LP

• Local skin sepsis at the site of puncture
• Clinically unstable patient
• Clinical suspicion of spinal cord compression
• Coagulopathy or bleeding disorders
• Platelet count less than 100 x 10^9/L
• Use of anticoagulant medication, such as warfarin or novel oral anticoagulants (NOACs)

Procedure and Technique

• Use of atraumatic needles (e.g., 24 G) to reduce the risk of post-LP headache
• Needle diameter and length should be chosen based on patient characteristics, such as obesity
• LP can be performed with the patient in either a lateral recumbent (supine) or sitting position
• Active withdrawal of CSF through a syringe is not recommended, as it increases the risk of post-LP headache
• Gravity flow removal is preferred, and the volume of CSF withdrawn should be limited to 5-12 mL

Adverse Events

• Post-LP headache is the most common adverse event, occurring in up to 9% of patients
• Back pain, nausea, vomiting, and dizziness are also possible adverse events
• Severe complications, such as infection, cerebral or spinal hemorrhage, and cerebral venous thrombosis, are rare but potentially disabling or fatal As stated by 1, the management of suspected viral encephalitis in adults includes LP as a diagnostic tool, and the procedure should be performed with caution in patients with coagulopathy or bleeding disorders. Additionally, 1 highlights the importance of using atraumatic needles and proper technique to reduce the risk of post-LP headache and other adverse events.

From the Research

Indications for Lumbar Puncture

The indications for lumbar puncture (LP) in an adult with muscle fasciculations, a symptom of potential neurological disorders, include:

• Diagnostic indications such as infectious, inflammatory, and neoplastic diseases affecting the central nervous system 2
• Investigation of inflammatory or infectious disease of the nervous system 3
• Evaluation of acute headache 4, 3
• Diagnosis of conditions such as aseptic meningitis, bacterial meningitis, Guillain-Barré syndromes, subarachnoid hemorrhages (SAH), and carcinomatous meningitis 5
• Encephalopathy 4

Specific Conditions

LP may be indicated in the following specific conditions:

• Muscle fasciculations, which can be a symptom of neurological disorders such as amyotrophic lateral sclerosis (ALS) or other motor neuron diseases, although this specific indication is not explicitly mentioned in the provided studies
• Acute severe headache, which may be indicative of conditions such as SAH or meningitis 4
• Encephalopathy, which can be caused by a variety of conditions including infections, inflammation, or metabolic disorders 4

Importance of Lumbar Puncture

LP is an important tool in the diagnosis of neurological diseases, and its use can provide valuable information for the diagnosis and treatment of central nervous system disorders 2, 6