How Long Does A Lumbar Puncture Take

A patient undergoing a lumbar puncture, courtesy Brainhell, via Wikipedia

A lumbar puncture (or LP, and colloquially known as a spinal tap) is a diagnostic and at times therapeutic process that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological assay, or very rarely as a treatment ("therapeutic lumbar puncture") to relieve increased intracranial pressure. Information technology is one of the most common diagnostic procedures performed on House, M.D.

If the technique is performed college up on the spine near the neck, it is chosen acervical puncture.This is a far more dangerous procedure and is reserved for patients who cannot tolerate a normal lumbar puncture and are in dire need of the process.

Contents

• 1 History
• ii Indications
• 3 Contraindications
• 4 Procedure
• 5 Risks
• six Diagnostics
• 7 Appearances
  • 7.ane Therapy
  • vii.2 Outbreak
  • 7.3 The Workaround
  • seven.four The Feint
  • 7.5 The Dilemma
  • seven.half dozen Side Effects
  • 7.7 On The Wing
  • 7.8 Downward the incorrect route
  • seven.nine Personality
  • vii.10 Punishment
  • 7.eleven Basic Skills
  • vii.12 Other appearances
• 8 In other languages

History [ ]

The starting time technique for accessing the dural space was described by the London physician Dr. Walter Essex Wynter. In 1889, he developed a crude procedure to insert fluid drainage tubes in four patients with tuberculous meningitis. The primary purpose was the treatment of raised intracranial pressure rather than for diagnosis. The technique for needle lumbar puncture was so introduced by the German dr. Heinrich Quincke, who credits Wynter with the earlier discovery. Quincke first reported his experiences at an internal medicine conference in Wiesbaden in 1891. He afterwards published a book on the subject field.

The lumbar puncture procedure was taken to the The states by Arthur H. Wentworth Thousand.D., an assistant professor at the Harvard Medical Schoolhouse, based at Children'due south Hospital. In 1893, he published a long paper on diagnosing cerebrospinal meningitis past examining spinal fluid. His career took a nosedive, however, when antivivisectionists prosecuted him for having obtained spinal fluid from children. He was acquitted, but he was uninvited from the so forming Johns Hopkins Schoolhouse of Medicine, where he would have been the first professor of pediatrics.

Indications [ ]

The nigh common purpose for a lumbar puncture is to collect cerebrospinal fluid in a case of suspected meningitis, since there is no other reliable tool with which meningitis, a life-threatening just highly treatable status, can exist excluded. Young infants commonly require lumbar puncture as a role of the routine workup for fever without a source, as they have a much higher risk of meningitis than older persons and do not reliably show signs of meningeal irritation. In any age grouping, subarachnoid hemorrhage, hydrocephalus, idiopathic intracranial hypertension and many other diagnoses may be supported or excluded with this test.

Lumbar punctures may also be done to inject medications into the cerebrospinal fluid ("intrathecally"), particularly for spinal anesthesia or chemotherapy. It may also exist used to detect the presence of malignant cells in the CSF, as in carcinomatous meningitis or medulloblastoma.

Contraindications [ ]

Lumbar puncture should not be performed in the following situations

• Idiopathic increased intracranial force per unit area (ICP)
  • Rationale: lumbar puncture in the presence of increased ICP may crusade uncal herniation
  • Exception: therapeutic employ of lumbar puncture to reduce ICP
  • Precaution
    • CT Scan of the encephalon is advocated past some, especially in the post-obit situations
      • Age over 65
      • Reduced Glasgow Coma Scale or witting land
      • Recent history of seizure
      • Focal neurological signs
    • Ophthalmoscopy for papilledema
• Hereditary bleeding weather
  • Coagulopathy
  • Decreased platelet count
• Certain Infections
  • Skin infection at puncture site
  • Sepsis
• Abnormal respiratory pattern
• Loftier blood force per unit area with bradycardia and deteriorating consciousness
• Vertebral deformities (scoliosis or kyphosis), in hands of an inexperienced physician.

Process [ ]

In performing a lumbar puncture, first the patient is commonly placed in a left (or right) lateral position with the neck aptitude in full flexion and knees bent in full flexion up to the breast, approximating a fetal position every bit much as possible. Information technology is too possible to have the patient sit down on a stool and bend their head and shoulders forwards. The area around the lower back is prepared using aseptic technique. One time the advisable location is palpated, local coldhearted is infiltrated nether the skin and then injected along the intended path of the spinal needle. A spinal needle is inserted betwixt the lumbar vertebrae L3/L4 or L4/L5 and pushed in until there is a "give" that indicates the needle is past the ligamentum flavum. The needle is again pushed until at that place is a second 'give' that indicates the needle is now by the dura mater. Since the arachnoid membrane and the dura mater exist in affluent contact with one some other in the living person's spine (due to fluid pressure from CSF in the subarachnoid space pushing the arachnoid membrane out towards the dura), once the needle has pierced the dura mater it has as well traversed the thinner arachnoid membrane and is at present in the subarachnoid space. The stylet from the spinal needle is and so withdrawn and drops of cerebrospinal fluid are collected. The opening pressure of the cerebrospinal fluid may be taken during this collection by using a unproblematic column manometer. The procedure is ended past withdrawing the needle while placing pressure on the puncture site. In the by, the patient would often exist asked to lie on their dorsum for at least half dozen hours and exist monitored for signs of neurological bug, though there is no scientific testify that this provides any benefit. The technique described is almost identical to that used in spinal anesthesia, except that spinal anesthesia is more often done with the patient in a seated position.

The upright seated position is advantageous in that there is less baloney of spinal beefcake which allows for easier withdrawal of fluid. It is preferred by some practitioners when a lumbar puncture is performed on an obese patient where having them lie on their side would crusade a scoliosis and unreliable anatomical landmarks. On the other hand, opening pressures are notoriously unreliable when measured on a seated patient and therefore the left or right lateral (lying down) position is preferred if an opening pressure needs to be measured.

Patient anxiety during the process tin can pb to increased CSF pressure, peculiarly if the person holds their breath, tenses their muscles or flexes their knees too tightly against their chest. Diagnostic analysis of changes in fluid pressure during lumbar puncture procedures requires attention both to the patient'southward condition during the procedure and to their medical history.

Reinsertion of the stylet may decrease the rate of post lumbar puncture headaches.^[1]

Risks [ ]

Postal service spinal headache with nausea is the most common complexity; it often responds to analgesics and infusion of fluids. It was long taught that this complication can oftentimes be prevented by strict maintenance of a supine posture for ii hours after the successful puncture. Withal, this has not been borne out in modernistic studies involving big numbers of patients. Merritt's Neurology (tenth edition), in the department on lumbar puncture, notes that intravenous caffeine injection is often quite effective in aborting these so-called spinal headaches. Contact between the side of the lumbar puncture needle and a spinal nerve root can result in anomalous sensations (paresthesia) in a leg during the procedure. This is harmless and patients tin can be warned about information technology in advance to minimize their anxiety if information technology should occur. A headache that is persistent despite a long menstruum of bedrest and occurs only when sitting upward may be indicative of a CSF leak from the lumbar puncture site. It can be treated past more bedrest, or past an epidural claret patch, where the patient's own blood is injected dorsum into the site of leakage to cause a clot to grade and seal off the leak.

Serious complications of a properly performed lumbar puncture are extremely rare. They include spinal or epidural bleeding, adhesive arachnoiditis and trauma to the spinal cord or spinal nerve roots resulting in weakness or loss of sensation, or even paraplegia. The latter is exceedingly rare, since the level at which the spinal cord ends (normally the inferior border of L1, although it is slightly lower in infants) is several vertebral spaces above the proper location for a lumbar puncture (L3/L4). There are case reports of lumbar puncture resulting in perforation of abnormal dural arterio-venous malformations, resulting in catastrophic epidural hemorrhage. This is exceedingly rare.

The procedure is not recommended when epidural infection is present or suspected, when topical infections or dermatological conditions pose a hazard of infection at the puncture site (e.g. 3rd-degree burns) or in patients with severe psychosis or neurosis with back hurting. Some authorities believe that withdrawal of fluid when initial pressures are abnormal could result in spinal string compression or cerebral herniation; others believe that such events are merely coincidental in fourth dimension, occurring independently as a result of the same pathology that the lumbar puncture was performed to diagnose. In whatever case, computed tomography of the brain is often performed prior to lumbar puncture if an intracranial mass is suspected.

Removal of cerebrospinal fluid resulting in reduced fluid pressure has been shown to correlate with greater reduction of cerebral claret menstruation among patients with Alzheimer'south disease. Its clinical significance is uncertain.

Diagnostics [ ]

Increased CSF pressure can indicate congestive heart failure, cerebral edema, subarachnoid hemorrhage, hypo-osmolality resulting from hemodialysis, meningeal inflammation, purulent meningitis or tuberculous meningitis, hydrocephalus, or idiopathic intracranial hypertension.

Decreased CSF pressure can point complete subarachnoid blockage, leakage of spinal fluid, severe aridity, hyperosmolality, or circulatory plummet. Pregnant changes in pressure during the procedure can signal tumors or spinal blockage resulting in a large puddle of CSF, or hydrocephalus associated with big volumes of CSF. Lumbar puncture for the purpose of reducing pressure is performed in some patients with idiopathic intracranial hypertension (likewise called pseudotumor cerebri.)

The presence of white claret cells in cerebrospinal fluid is called pleocytosis. A small-scale number of monocytes can be normal; the presence of granulocytes is e'er an abnormal finding. A big number of granulocytes often heralds bacterial meningitis. White cells tin can also betoken reaction to repeated lumbar punctures, reactions to prior injections of medicines or dyes, central nervous system hemorrhage, leukemia, recent epileptic seizure, or a metastatic tumor. When peripheral blood contaminates the withdrawn CSF, a mutual procedural complication, white blood cells will be present along with crimson claret cells, and their ratio will be the same every bit that in the peripheral blood.

The finding of erythrophagocytosis where phagocytosed erythrocytes is observed, signifies bleeding into the CSF that preceded the lumbar puncture. Therefore, when erythrocytes are detected in the CSF sample, erythrophagocytosis suggests causes other than a traumatic tap, such as intracranial hemorrhage and haemorrhagic herpetic encephalitis. In which case, further investigations are warranted, including imaging and viral culture.

Several substances found in cerebrospinal fluid are available for diagnostic measurement.

• Measurement of chloride levels may aid in detecting the presence of tuberculous meningitis.
• Glucose is usually nowadays in the CSF; the level is usually about 60% that in the peripheral circulation. A fingerstick or venipuncture at the time of lumbar puncture may therefore be performed to appraise peripheral glucose levels in club to determine a predicted CSF glucose value. Decreased glucose levels can point fungal, tuberculous or pyogenic infections; lymphomas; leukemia spreading to the meninges; meningoencephalitic mumps; or hypoglycemia. A glucose level of less than one third of claret glucose levels in clan with low CSF lactate levels is typical in hereditary CSF glucose transporter deficiency also known as De Vivo illness.
• Increased glucose levels in the fluid can betoken diabetes, although the sixty% rule still applies.
• Increased levels of glutamine are often involved with hepatic encephalopathies, Reye's syndrome, hepatic blackout, cirrhosis and hypercapnia.
• Increased levels of lactate can occur the presence of cancer of the CNS, multiple sclerosis, heritable mitochondrial disease, low blood pressure, low serum phosphorus, respiratory alkalosis, idiopathic seizures, traumatic brain injury, cerebral ischemia, brain abcess, hydrocephalus, hypomania or bacterial meningitis.
• The enzyme lactate dehydrogenase can be measured to help distinguish meningitides of bacterial origin, which are often associated with high levels of the enzyme, from those of viral origin in which the enzyme is low or absent.
• Changes in full protein content of cerebrospinal fluid tin can upshot from pathologically increased permeability of the blood-cerebrospinal fluid barrier, obstructions of CSF apportionment, meningitis, neurosyphilis, brain abscesses, subarachnoid hemorrhage, polio, collagen illness or Guillain-Barre syndrome, leakage of CSF, increases in intracranial pressure or hyperthyroidism. Very loftier levels of poly peptide may indicate tuberculous meningitis or spinal block.
• IgG synthetic rate is calculated from measured IgG and total protein levels; it is elevated in immune disorders such as multiple sclerosis, transverse myelitis, and neuromyelitis optica of Devic.
• Numerous antibiotic-mediated tests for CSF are available in some countries: these include rapid tests for antigens of mutual bacterial pathogens, treponemal titers for the diagnosis of neurosyphilis and Lyme disease, Coccidioides antibody, and others.
• The India ink examination is nevertheless used for detection of meningitis caused by Cryptococcus neoformans, only the cryptococcal antigen (CrAg) exam has a college sensitivity.
• CSF can be sent to the microbiology lab for diverse types of smears and cultures to diagnose infections.
• Polymerase concatenation reaction (PCR) has been a great advance in the diagnosis of some types of meningitis. It has high sensitivity and specificity for many infections of the CNS, is fast, and can be done with minor volumes of CSF. Even though testing is expensive, information technology saves cost of hospitalization.

Appearances [ ]

Lumbar puncture is a commonly depicted process on House, G.D.. Information technology has appeared in almost every episode of the series.

Therapy [ ]

In Paternity, Dan's symptoms initially pointed to neurosyphillis. He needed an injection of penicillin directly into his cerebro-spinal fluid, but he already had loftier CSF force per unit area. House suggested, that they do an LP and inject the penicillin straight through the puncture bespeak. As the patient already had a shunt in place, the excess pressure level could drain through it.

Nevertheless, when they did the LP, the patient started hallucinating. In addition, the treatment didn't work.

Outbreak [ ]

The series' only true exposure to meningitis was in Kids, when a oversupply at a swimming contest was exposed to an active case. Most a third of the crowd was sent to Princeton-Plainsboro Teaching Hospital where the staff was overwhelmed by having to screen virtually 800 people for outward symptoms of the disease - fever, a strong neck and a rash. Those who met the criteria had to be quarantined and receive farther tests to confirm.

While beingness forced to practice routine examinations by Cuddy, House came beyond a immature diver who meet all of the criteria. Yet, the diver insisted she had had the rash for about a week (a meningitis rash kills within a couple of days) and House noted that she only had stiffness in ane management. He convinced Cuddy the diver may not have meningitis and got Chase and Foreman assigned to him to work on the diver for one hour earlier they had to return to screen other patients.

However, even Firm had to admit he may be wrong and ordered Foreman to do a lumbar puncture to rule out meningitis. Foreman went to Nurse Previn to attempt to get a process room, but she turned him downwardly due to the piece of work from the outbreak. As a event, Foreman and the diver'due south coach performed the lumbar puncture while she was lying on a gurney.

Later the process, an orderly came to get the gurney, and the diver had to be moved to a burrow. Foreman admonished the orderly, who apologized and said he needed the gurney. Foreman reminded him that LP patients usually require several hours of rest without being moved post procedure in order to avoid complications.

Luckily, the LP ruled out meningitis.

The Workaround [ ]

With Foreman in accuse in Deception, Business firm was trying to convince him that Anica Jovanovich's symptoms are the result of a recurrence of her Cushing'south syndrome. However, Foreman is sure it's an infection and orders an LP. He also orders Firm to perform information technology. However, Firm is not nearly to be defeated that easily. Instead of doing the LP in a straightforward manner, he instead seems to be clumsy and pokes her repeatedly with the needle. Her blood pressure spikes, showing a hypertensive crisis typical of Cushing'south. Foreman concedes and allows Firm to scan for a microtumor one time they rule out alcohol withdrawal.

The Feint [ ]

In Failure to Communicate, Foreman was still technically in accuse of the example of aphasic journalist Fletcher Stone, only when he ran out of ideas, he finally got in touch with Firm, who was in Baltimore dealing with Medicaid. House suspects the patient in nevertheless hiding something, but he'due south so committed to concealing it, they have to scare information technology out of him. He tells the team to face up the patient to come across if he's hiding something and make information technology clear to him that he will die if he's keeping something back. He likewise orders Cameron to do an LP in instance it is meningitis or multiple sclerosis, despite the risk of paralysis given the patient's condition.

Foreman and Chase dutifully tell the patient he will near likely die if he's belongings something back, only he remains silent. Nevertheless, equally Cameron goes to do the LP, she tries to comfort the patient. This makes the patient start blurting out "I couldn't handle the bear! They took my stain!".

House later admits to Cameron that she knew he would comfort the patient and that he was setting up a "expert cop, bad cop" situation to put the force per unit area on the patient. The patient'due south outburst eventually leads House to the right answer.

The Dilemma [ ]

Patients with burns that embrace the spine cannot receive an LP - the burned skin cannot be properly sterilized and information technology is likely whatever biological pathogens on the skin would contaminate the CSF and crusade a fatal infection.

However, in the episode Distractions, the patient Adam suffered from such burns, and his symptoms pointed to either an infection or multiple sclerosis. With options running out, House ordered a cervical puncture, which is performed much higher on the neck and poses a far greater risk of paralysis. Despite objections from the team, House said they had no other choice and they convinced the patient's parents to consent.

The process did not get well. Foreman tried to insert the needle in the C2:C3 space, but could find no passage. He decided to move up one vertebrae to C1:C2. Chase warned him of the possibility of a brain hernia, and, in addition, Adam's blood pressure started to spike, risking a stroke. Foreman managed to complete the procedure. Even so, the tests on the CSF were negative.

Side Furnishings [ ]

It doesn't happen very oft, merely on occasion i procedure provides a totally unrelated clue.

In Whac-A-Mole, the most likely cause of Jack Walters' vomiting was an infection. As such, House ordered Foreman to do an LP. The procedure went smoothly and Foreman even got assistance from Jack's younger sister Kama. However, as they rolled him onto his dorsum after the procedure, they broke one of Jack's ribs and realized he also had osteomyelitis.

On The Wing [ ]

While flying back from Singapore in the episode Airborne, Gregory Firm and Lisa Cuddy found themselves with a passenger who was suffering from nausea, rash vomiting and ataxia. Fifty-fifty worse, no-one on the flight spoke the passenger's language, Korean, and then getting a medical history was impossible. Cuddy was certain that the passenger had bacterial meningitis and wanted to land the airplane immediately. However, House thought she was panicking and played downwards the take chances. However, when another woman and Cuddy came downwards with the same symptoms, the plane was past it's indicate of no return and had to go on on to New York. It was likely that nearly of the passengers would become infected by and so if information technology was meningitis.

Later ruling out several other possibilities, House realized he had to jury rig a lumbar puncture using an emergency syringe. Given the probable turbulence, the procedure might result in spinal cord damage. However, House completed the procedure successfully and saw the cerebro-spinal fluid was clear. He realized the rest of the sick people were suffering from conversion disorder, merely withal had no answer for the original ill passenger, who continued to get sicker.

Conversely, in the same episode, Fran is too given an LP in perfect weather despite the risk due to her status. It tests positive for red claret cells, leading the team to believe, mistakenly, that she had bleeding in her brain. They narrowly avoided burr hole surgery when Chase, who didn't believe the diagnosis, had an epiphany and plant the real crusade elsewhere.

Downwards the wrong road [ ]

In House Grooming, one of the near obvious causes for Lupe'south ebulia was an infection. As such, she had had an LP even before she reached Business firm. However, it was totally clear and Lupe's lack of fever convinced everyone except Foreman that information technology must be some blazon of autoimmune status. However, Foreman disagreed, thinking Lupe had a rare form of cancer. He argued that Lupe should get radiation therapy - if it were cancer, it was her just adventure, and the simply major side issue of the treatment was immunosuppression, which would exist helpful if it was an autoimmune condition. Business firm agreed.

Nonetheless, after the commencement treatment, Lupe couldn't stand up the pressure of the blood pressure monitor. When Firm learned of this, he realized it pointed to sepsis and that the radiation therapy had destroyed Lupe'south immune system. She was last. House realized the negative LP only meant that the infection was in her heart instead of her brain.

Personality [ ]

In Mirror Mirror, Firm thought the patient might have an autoimmune condition and ordered Lawrence Kutner to practice an LP on the Mirror Patient. When Kutner warned the patient that it might injure, the patient told him to "bring on the pain". Kutner protested he wasn't a masochist, but the patient denied being 1 as well. However, as he went on, he identified Kutner as someone who felt he needed to accept a abiding stream of new experiences and couldn't stand existence just similar everyone else.

Penalization [ ]

In order to avoid the inevitability of Chase proposing to her before she'southward ready to make a decision, Cameron brings the case of Doug Svenson to Firm and claims she needs to stay at the infirmary to make certain Business firm stays on the case. House knows something is up, but can't put his finger on it. He decides to have some fun with Cameron. Information technology's immediately apparent that the patient may have multiple sclerosis. An LP would exist a good diagnostic exam except for i thing - the patient has hiccups and can't lie still. Business firm orders Cameron to do it anyway. Fifty-fifty with Kutner'southward aid, she can't do it with the patient jerking around, so she finally gets a sedative and administers information technology over Kutner'south objections.

Basic Skills [ ]

Due to her involvement with Business firm, Martha M. Masters didn't always become fourth dimension to come across the applied requirements for graduating medical school. In Last Temptation, on the concluding day of classes, Masters was still trying to perform her tenth and last lumbar puncture.

At first, her classmate Cruz did two lumbar punctures (giving him well over ten) in lodge to thwart her. However, when she learned of another patient, she found that House had beat her to the patient and performed the procedure himself. He then took Masters' log volume and confirmed that she had done the LP. Masters protested, but House asked if she knew how to exercise an LP. Masters said of grade she did, and Firm countered if she knew how to do nine LPs and say she did ten. He told Masters he would hire her as an intern if she turned in her log book.

Nevertheless, Masters couldn't practise it. Instead, when Xiii found out about information technology, she let Masters practise a routine LP on her to meet the requirement. When Masters turned in her completed log book, House took 1 look at 13 and realized she had had a recent LP. He fired Masters on the spot.

Other appearances [ ]

• Jeff Forrester is given an LP in Spin to rule out infection.
• George narrowly avoided an LP in Que Sera Sera when he regained consciousness just afterward Cameron suggested the process.
• During House's hallucination in No Reason, he decides to do a high risk LP on Vince because he has run out of other options. Like all the other "tests", information technology is negative.
• Boyd and his father Walter refuse an LP, as well as whatever other procedure, subsequently the diagnosis of Boyd's tuberous sclerosis in House vs. God
• In Acceptance, Foreman uses the procedure to deliberately cause a footling more pain for Clarence, a death-row inmate. When Clarence complains, Foreman asks why a tough guy like him can't accept it.
• In Merry Picayune Christmas, Cuddy is struggling for a diagnosis for Abigail Ralphean and orders an LP forth with other tests. However, her dubiousness but convinces the patient's mother that the doctors have no thought what'south incorrect with her.
• In Games, Thirteen performs a hole-and-corner LP on Jimmy Quidd because she thinks he might have meningitis.
• Gary H. Wright gets a routine LP as part of his concrete piece of work-up in Role Model.
• A routine LP on Henry Errington shows he has white claret cells in his CSF, indicating an infection.
• House orders an LP on Melinda Bardach in Safe looking for an infection, merely the test is normal.
• Cameron suggests that they perform an LP on Lee in Locked In to rule out Behcet'due south disease and autoimmune conditions.
• In Autopsy, Andie is given an LP to rule out graft versus host disease from her contempo bone marrow transplant.
• In Ugly, Taub thinks Kenny Arnold is just suffering from increased intracranial pressure due to his facial deformity. Yet, House is convinced that the patient's congenital condition has cypher to practice with his current illness and consistently thwarts Taub when Taub comes up with contrived reasons why they should perform an LP that would ostend the patient'south intracranial pressure.
• House ordered an LP on Alex in Skin Deep to rule out brain damage from her center attack.
• Kyle Wozniak was given a routine LP in Son of Blackout Guy.
• In Teamwork, Firm ordered an LP on Hank Hardwick and punished Foreman by making him practise the LP and all the other routine tests.
• Foreman thinks Derek Hoyt might take meningitis in Words and Deeds and suggests an LP, which House agrees to.
• In Insensitive, Hannah Morgenthal's LP is normal despite her high fever.
• House ordered an LP on Mickey in The Downwards Low when he suspected an infection.
• With fellows by the dozens in The Correct Stuff, House got a few of them to perform an LP on Greta Cooper. Using his remaining applicants in Guardian Angels, he also ordered an LP on Irene.
• Foreman also took advantage of the extra help in Need to Know by ordering an LP on Casey Alfonso to dominion out meningitis.
• In Knight Fall, Firm won't let Chase do an LP on Sir William because he thinks that information technology's unlikely to be food poisoning.
• In The Option, Taub suggests cognitive infection and Business firm agrees to let him to an LP on Theodore Philip Taylor.
• Jay Dolce, the operator of the crane in Assist Me, was given an LP. Information technology was normal.
• Bert Eskey is given an LP in Recession Proof. It is normal.
• Due to Lane'due south numerous existing injuries, in Out of the Chute they have to give him a ventricular puncture instead.
• Cyrus Harry had already been given an LP before he even reached Business firm in Changes.
• Ramon Silva is given an LP in Small Sacrifices, and before the procedure House takes the opportunity to make fun of the patient's beliefs before Hunt throws him out.
• Park performs an LP on Derrick in Property On. It shows his CSF force per unit area is very high.
• In Nobody's Fault, House takes the opportunity to utilize a racial epithet on Park when she fails to notation that Nib Koppelman has already had an LP and the results rule out her diagnosis of normal pressure level hydrocephalus.
• In Man of the House, Business firm orders an LP on Joe Reese to try to ostend multiple sclerosis.
• In The C Word, they perform an LP on Emily Lawson to try to confirm Lyme disease

In other languages [ ]

Language	Name
Spanish	Punción lumbar
French	Ponction lombaire
German	Lumbalpunktion
Portuguese	Punção lombar

This article was largely developed from the article of the same name at Wikipedia [1]

1. ↑ http://www.nejm.org/doi/full/10.1056/NEJM199704173361616

Source: https://house.fandom.com/wiki/Lumbar_puncture

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