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J Neurol Neurosurg Psychiatry. 1987 August; 50(8): 1071–1074.
PMCID: PMC1032242

Contraindications to lumbar puncture as defined by computed cranial tomography.


Papilloedema is not always an adequate predictor of potential complications from lumbar puncture, and many clinicians are using computed tomography (CT) before lumbar puncture in an effort to identify more accurately the "at risk" patient. This paper identifies the following anatomical criteria defined by CT scanning that correlate with unequal pressures between intracranial compartments and predispose a patient to herniation following decompression of the spinal compartment: lateral shift of midline structures, loss of the suprachiasmatic and basilar cisterns, obliteration of the fourth ventricle, or obliteration of the superior cerebellar and quadrigeminal plate cisterns with sparing of the ambient cisterns. These criteria should be considered to be contraindications to lumbar puncture.

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Selected References

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  • KOREIN J, CRAVIOTO H, LEICACH M. Reevaluation of lumbar puncture; a study of 129 patients with papilledema or intracranial hypertension. Neurology. 1959 Apr;9(4):290–297. [PubMed]
  • Lafforgue JL, de Coninck L, Cales J, Bagot M, Sabathié M. A propos de la ponction lombaire: indications et limites. Cah Anesthesiol. 1984 Mar;32(2):113–117. [PubMed]
  • Humphreys RP. Computed tomography and the early diagnostic lumbar puncture. Can Med Assoc J. 1979 Jul 21;121(2):150–151. [PMC free article] [PubMed]
  • Sadhu VK, Sampson J, Haar FL, Pinto RS, Handel SF. Correlation between computed tomography and intracranial pressure monitoring in acute head trauma patients. Radiology. 1979 Nov;133(2):507–509. [PubMed]

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