Abstract

ESPINOSA JOVEL, Camilo Alfonso et al. Usefulness and diagnostic efficiency of the lumbar puncture in the emergency service. Acta Neurol Colomb. [online]. 2015, vol.31, n.1, pp.39-48. ISSN 0120-8748.  https://doi.org/10.22379/242240226.

Introduction: Lumbar puncture is a diagnostic and therapeutic procedure necessary for many illnesses of the nervous system. Its usefulness in the emergency service has not yet been completely explored in the literature. Objectives: To describe the frequency of lumbar puncture in the emergency department, its usefulness for diagnosing illnesses of the nervous systems, and to describe the most relevan demographic and clinical characteristics of the patients on whom the procedure was done. Materials and methods: We did an observational, descriptive and transversal study. All data was prospectively recorded, relating to patients treated in the emergency service of the department of Neurology in the Hospital Occidente de Kennedy in Bogotá Colombia. Patients considered were given a lumbar puncture within a period between January 2012 and July 2013. Results: 3.161 patients were diagnosed in the Neurology emergency service and 630 lumbar punctures were done (19.9%). The main indications for doing this procedure were: headaches with warning signs (40.6%) and suspected neuroinfection (27.5%). 32.2% (IC 95%: 28.5-35.8) of lumbar punctures had an abnormal result. The usefulness of lumbar punctures went down in the group of patients over the age of 65 (24.5% n=26). When a lumbar puncture is done because a neuroinfection is clinically suspected, its usefulness can reach 40.46% (IC 95%: 33.1-48.1). A history of HIV has a significant association with abnormal lumbar punctures (p <0.0001). Headaches (70% n=144) and fever (26.1% n=53) were the most frequent symptoms within the group of patients with abnormal lumbar puncture. Fever, subtle meningeal signs and rigidity of the neck were the clinical variables which presented statistic significance (p <0.05), and were associated to a definitive diagnosis of neuroinfection. Within this group of patients, alteration of consciousness (33% n=8) and rigidity of the neck (12.5% n=3) were more frequent in neutrophilic meningitis compared to lymphocitic meningitis. Endocraneal ideopathic hipertension was the second most frequent definitive diagnosis (23.6% n=48), and from this group, 62.4% satisfied the clinical criteria for daily chronical headache. Conclusions: Lumbar puncture is a frequent and useful procedure in the Neurology emergency service, done primarily on young adults who consult for headaches with signs of alarm, and in cases of a clinical suspicion of neuroinfection. An infection of the central nervous system still represents the most frequent definitive diagnostic; within this group of patients, the clinical picture and the associated comorbilities can help realize the etiological perspective. The high percentage of patients suffering from daily chronic headaches and endocraneal hipertension as the only abnormal finding in the lumbar puncture, supports the hypothesis that ideopathic endocraneal hipertension could be a determining factor in the progression of some primary headaches.

Keywords : Lumbar puncture; Headache; Emergency Department; Meningitis.

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