Lumbar puncture — myths, misconceptions

Forward Nyanyiwa
Tendai Nhombo (not real name) winces with pain as he sweats on already soaked bed sheets. Nhombo has been pulled out of hospital against medical advice, after his wife and mother rejected the doctor’s request to do a lumbar puncture to try and come up with a diagnosis.

The procedure might be fatal as was with the case with his brother some years ago, they say.

A lumbar puncture, also known as a spinal tap, is a procedure to collect and look at cerebrospinal fluid (CSF) surrounding the brain and spinal cord. A needle is inserted into the spinal canal, low in the back. “As a family, we decided not to have the procedure done because we concurred it would be fatal. Nobody who has had that procedure has survived and his late brother is a good example after he collapsed and died some years back following the procedure,” says Nhombo’s wife as she wipes froth from her husband’s mouth.

A colleague helping her chips in: “If you don’t die you become paralysed. It is a scary procedure.” Many people have the perception that lumbar punctures kill, or at best causes paralysis.

Former Health and Child Care Deputy Minister Dr Edwin Muguti says, “Naturally, people react because of previous experiences. There might have been some disasters years back and thus the general perception that lumbar punctures kill. But they do not kill at all. “A lumbar puncture remains an essential investigation for doctors to perform targeted treatment. It is done to confirm the causative organism of meningitis because we have different types of meningitis, namely viral meningitis, bacterial meningitis, fungal meningitis and tuberculosis meningitis.”

He says one can be treated for meningitis without a lumbar puncture, but the prognosis is not as good when compared to a patient who first undergoes the procedure. “A patient can be treated for meningitis without doing the lumbar puncture but the outcome is different from one who will have got the procedure done because the issue of targeted treatment comes into play. But it is my view that doctors continue to learn so that these procedures be done frequently to allay the negative perceptions.

Senior doctors should take it upon themselves to supervise their junior counterparts so that we don’t have any disasters but any qualified doctor can perform a lumbar puncture successfully,” he adds.

Another medical specialist, who prefers anonymity, weighs in: “Years back before ARVs, people would visit health centres already terminally ill, and when doctors tried to do investigations, lumbar punctures included, some would die even before receiving medication. Relatives would then conclude that it was because of the procedure.”

He also says a factor that can lead to a lumbar puncture being fatal is that of raised intracranial pressure (ICP); so it is recommended that before performing the procedure, a computerised tomography (CT) scan is done first. “Before one performs a lumbar puncture, a CT scan is supposed to be taken to rule out raised ICP, space occupying lesions like tuberculoma, lymphoma and toxoplasmosis. If CT scan is not done and the procedure is done with a raised ICP, it is fatal because it causes herniation. The brain collapses.

“But how many of us can afford to have a CT scan before a lumbar puncture? And it is not a normal CT scan, it is the one which is supposed to have a contrast. It is expensive so some people end up having the lumbar puncture though with dreaded results.”

A CT scan averages US$300 in public hospitals and about US$600 at private healthcare facilities.

A lumbar puncture has minor side effects. “Of course, there are some side effects which include post-lumbar puncture headache mainly due to leaking CSF, some bleeding from the insertion area and back pain, but they are all manageable,” the doctor says.

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