What reactions may occur during lumbar puncture operation and how to manage them

1. Hypocranial pressure syndrome: refers to the lateral decubitus position cerebrospinal fluid pressure below 0.58 to 0.78kPa(60 to 80mm water column), is more common. Because the needle is too thick, the puncture technology is not skilled or get up too early after the operation, so that the cerebrospinal fluid from the spinal membrane puncture hole continuous outflow caused by patients in sitting up after the headache is significantly aggravated, severe patients with nausea and vomiting or dizziness, fainting, supine or head low headache can be alleviated or relieved. A few can appear consciousness disorder, mental symptoms, meningeal stimulation, etc., lasting about one to several days. Therefore, fine needle puncture should be used, after the operation, go to the pillow supine (best prone) 4-6 hours, and drink more water (avoid drinking strong tea, sugar water) can often be prevented, if it has happened, in addition to asking the patient to continue to recumbent and drink more water, but also as appropriate intravenous injection of distilled water 10-15ml or intravenous drip 5% grape brine 500-1000ml, 1-2 times /d, several days, often can be cured. 20-30ml of normal saline can also be injected into the spinal canal or the epidural again to eliminate the negative pressure in the epidural space to prevent cerebrospinal fluid from continuing to leak out.

2. Formation of cerebral hernia: when intracranial pressure increases (especially in posterior cranial fossa and temporal gyri space-occupying lesions), cerebral hernia may occur at the time of puncture or within a few hours after surgery when the drainage is too fast and too much, so strict attention and prevention should be paid. If necessary, before ordering, rapid intravenous infusion of 20% mannitol solution 250ml and other dehydrating agents, fine needle puncture, slowly drop a few drops of cerebrospinal fluid for laboratory examination. If unfortunate once appear, should immediately take the corresponding rescue measures, such as intravenous injection of 20% mannitol 200-400ml and hypertonic diuretic dehydrating agent, if necessary, can also be from the ventricle puncture discharge fluid and from the spinal canal rapid injection of physiological saline 40-80ml, but generally more difficult to work.

3. Sudden aggravation of symptoms of original spinal cord and spinal nerve root: more common in spinal cord compression, due to the change of pressure after lumbar puncture drainage, resulting in changes in the pressure balance between spinal cord, nerve root, cerebrospinal fluid and lesions. It can aggravate the symptoms of root pain, paraplegia and dyspnea, and can cause dyspnea and arrest in high cervical spinal cord compression. If the above symptoms are not serious, 30-50ml normal saline can be injected into the spinal canal first: if the efficacy is not good, please consider surgical treatment in emergency.

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