Today's article aims to bring everyone closer to what a lumbar puncture is. I have gathered in a brief description all the information I searched for after being diagnosed with MS. Did I decide to have a lumbar puncture? The answer is: NO.
- Why?
Because the head of the hospital I ended up in told me bluntly that regardless of the result, I would still be classified as having MS. In my case, it was yet another pointless examination that would not have answered any of my questions.
Remember that a lumbar puncture is merely the collection of cerebrospinal fluid from the spine, and what tests will be performed with this fluid depends entirely on the hospital. Therefore, we should not ask if someone had a lumbar puncture, but WHAT TESTS WERE DONE WITH THE COLLECTED CSF (cerebrospinal fluid).
In my humble opinion, if we decide on such an invasive procedure, it is essential to perform tests that exclude neuroborreliosis, which presents similar, if not identical, symptoms to MS. Key among these is the detection of specific anti-Borrelia IgG or IgM antibodies in the CSF.
We will delve into this and other causes that present an identical clinical picture to MS in the next article in February. For now, let's focus on the lumbar puncture itself and the basic tests performed in most hospitals, which, in my opinion, do not contribute much to the diagnosis.
Lumbar Puncture – What Is It and When Is It Worth Doing?
A lumbar puncture is a frequently used procedure in medicine. Its goal is to relieve altered areas of disease, administer medications, or collect material for microscopic examination.
Many people fear this procedure, primarily due to the pain and potential complications. Learn what exactly a lumbar puncture is, when it should be performed, and how to prepare for it properly.
What is a Lumbar Puncture?
A lumbar puncture is an invasive procedure. It involves puncturing a selected part of the body to collect a sample for examination or to remove fluid from a diseased organ. The lumbar puncture can refer to various organs.
The most common types of punctures performed are:
- Lumbar puncture;
- Joint and knee puncture;
- Pleural puncture;
- Kidney puncture;
- Sinus puncture;
- Ovarian cyst puncture;
- During pregnancy.
Due to its invasive nature, there is always a risk of complications with a lumbar puncture. However, it is reassuring that the procedure does not take much time and is generally painless. A lumbar puncture is typically performed under local anesthesia, and in some cases, even under general anesthesia.
A lumbar puncture is performed, for example, in cases of sinusitis, pleurisy, lung infections, heart failure, kidney failure, tuberculosis, cancer, or multiple sclerosis. In the latter situation, a doctor orders a lumbar puncture.
Indications for a Lumbar Puncture
A lumbar puncture is performed when it is necessary to examine the cerebrospinal fluid. During pregnancy, it is needed to assess the risk of fetal congenital defects. It is also used in in vitro fertilization.
Lumbar Puncture – What You Should Know?
The lumbar puncture is the most common type of puncture. It is ordered for patients suspected of having central nervous system infections, such as meningitis or encephalitis. However, these are not the only situations where this procedure is performed.
A lumbar puncture can also be performed in cases of:
- Autoimmune diseases (e.g., multiple sclerosis);
- Metabolic diseases;
- Unexplained seizures;
- Neuropathies;
- Suspected subarachnoid hemorrhage.
During the lumbar puncture procedure, epidural anesthesia or cancer therapy drugs can be administered.
How to Prepare for a Lumbar Puncture?
To perform a lumbar puncture, the patient's informed consent is essential. Preparation involves undergoing a few basic tests, primarily related to blood coagulation.
To assess blood clotting, a complete blood count with platelet levels, INR, and APTT should be performed. Increased intracranial pressure must be ruled out in the patient, as it is an absolute contraindication to lumbar puncture.
This requires an eye fundus examination by an ophthalmologist or a CT scan. Only after checking the patient’s health condition can the lumbar puncture be performed.
How is a Lumbar Puncture Performed?
The patient must lie on their side at the edge of the examination table, back to the doctor. The lower limbs should be bent at the knees and hips, with knees drawn as close to the abdomen as possible.
The head should be bent toward the knees. The lumbar puncture involves inserting a needle into the subarachnoid space of the spine, usually between the fourth and fifth lumbar vertebrae. A sterile dressing is applied at the puncture site.
The lumbar puncture procedure takes no more than a few minutes. It can be performed on both children and adults. After the procedure, the patient should remain lying flat for at least an hour to reduce the risk of post-lumbar puncture syndrome.
Possible Complications After a Lumbar Puncture
Within 24 to 48 hours after a lumbar puncture, the following symptoms may occur:
- Severe headache;
- Nausea;
- Vomiting;
- Dizziness;
- Visual disturbances;
- Ringing in the ears;
- Meningeal signs.
Lumbar Puncture and MS
In various nervous system disorders, the composition of cerebrospinal fluid differs. This can be helpful in diagnosing multiple sclerosis (MS). The fluid shows abnormal composition in 90% of MS patients and 40% of those suspected of having the disease.
The protein increase is small, less than 1g per liter of fluid. In most cases of MS, there is a percentage increase in monoclonal immunoglobulins. However, caution is needed in diagnosis, as an increase in these proteins can also occur in other nervous system diseases and some infections. The cell count increase is minor, usually below 50/mm3.
Important Considerations in Diagnosing MS Using a Lumbar Puncture
It is crucial to note additional issues. Some neurological diseases, such as meningitis, neuroborreliosis, and Guillain-Barré syndrome, lead to the disruption of the blood–brain barrier, increasing its permeability and raising protein levels, including immunoglobulins.
During the inflammatory process in MS, B lymphocytes cross the blood-brain barrier, transform into plasma cells within the CNS, and produce immunoglobulins. This automatically leads to intrathecal synthesis and an increase in immunoglobulin concentration in the cerebrospinal fluid.
Therefore, to diagnose a patient correctly, the first step should be to exclude causes other than multiple sclerosis for the high immunoglobulin concentration.
Characteristic Symptoms of MS
To diagnose primary progressive MS, a neurologist must observe continuous health deterioration and at least two of the following symptoms:
- At least one demyelinating lesion in the brain in one or more locations;
- At least two demyelinating lesions in the spinal cord;
- The presence of at least two oligoclonal IgG bands in the cerebrospinal fluid, indicating ongoing CNS inflammation.
The Most Accurate Method for Diagnosing MS with a Lumbar Puncture
The most accurate method for detecting oligoclonal bands is isoelectric focusing on an agarose gel. These bands appear in the cerebrospinal fluid of the vast majority of people with multiple sclerosis.
Additional Tests Worth Performing When Diagnosing MS
Diagnosing multiple sclerosis should not rely solely on cerebrospinal fluid examination. Abnormalities in its composition can also appear in other diseases, particularly neurological, autoimmune, or infectious diseases.
MRI can also be helpful in diagnostics, showing characteristic changes in the myelin sheaths of nerves. It is also essential to consider that demyelination can have various sources. As mentioned at the beginning, these and other imaging issues related to MS will be covered in the February article.
Author: Andy - CEO of Biomelius LTD, who was diagnosed with MS in 2017
Sources:
- [Medme](https://www.medme.pl/artykuly/punkcja-co-to-jest-i-jakie-groza-powiklania,67674.html)
- IDN](http://idn.org.pl/sm/Medyk/Punkcja.htm)
- [DOZ](https://www.doz.pl/czytelnia/a14755-Punkcja_ledzwiowa__wskazania_przebieg_zabiegu_i_mozliwe_powiklania)
- [PTSR](https://ptsr.org.pl/strona/51,diagnozowanie-sm)
