Lumbar Puncture Basics Quiz

Neurological Disorders

• Diagnostic Procedures: Lumbar puncture analyzes cerebrospinal fluid (CSF) for infections or multiple sclerosis (MS). Normal CSF values include protein 15-60 mg/dL and WBCs less than 5 cells/mm³. Post-procedure, patients should lie flat to prevent headaches. CT/MRI scans detect strokes, tumors, or structural damage. EMG evaluates neuromuscular disorders, while evoked potentials measure nerve conduction speed.

Amyotrophic Lateral Sclerosis (ALS)

• Pathophysiology: Motor neurons in the brain and spinal cord degenerate, leading to muscle weakness and atrophy.
• Clinical Manifestations: The disease causes weakness, spasticity, dysarthria (difficulty speaking), dysphagia (difficulty swallowing), and respiratory failure.
• Diagnostic Exams: EMG shows decreased nerve conduction, and MRI rules out other conditions.
• Management: Riluzole slows disease progression. Treatment focuses on symptom management with respiratory support, physical therapy, and communication aids. Nursing interventions include monitoring respiratory status to prevent aspiration, and providing communication support.

Guillain-Barré Syndrome (GBS)

• Pathophysiology: An autoimmune demyelination of peripheral nerves, often following an infection.
• Clinical Manifestations: Ascending weakness, areflexia (loss of reflexes), paresthesia (pins and needles), and respiratory compromise.
• Diagnostic Exams: Lumbar puncture reveals elevated protein in CSF; EMG shows reduced conduction velocity.
• Management: IV immunoglobulin (IVIG) or plasmapheresis is used; supportive care is provided during recovery, including monitoring respiratory function and preventing complications like deep vein thrombosis (DVT).

Multiple Sclerosis (MS)

• Pathophysiology: An autoimmune demyelination of central nervous system (CNS) neurons, disrupting nerve signals.
• Clinical Manifestations: Symptoms include fatigue, vision problems, spasticity, and bowel/bladder dysfunction.
• Diagnostic Exams: MRI detects CNS lesions called plaques; lumbar puncture may reveal oligoclonal bands in CSF.
• Management: Immunomodulators (e.g., interferon), corticosteroids (for exacerbations), symptom management, and physical therapy. Nursing care focuses on managing symptoms like fatigue and spasticity, and education about triggers.

Myasthenia Gravis (MG)

• Pathophysiology: Autoimmune destruction of acetylcholine receptors.
• Clinical Manifestations: Muscle weakness, ptosis (drooping eyelids), and difficulty swallowing.
• Diagnosis: Tests include an acetylcholine receptor antibody test and a Tensilon test (edrophonium).
• Treatment: Plasmapheresis for crises; medications like Pyridostigmine and corticosteroids, supportive care.

Cerebrovascular Accidents (CVAs)

• Transient Ischemic Attack (TIA): Brief periods of ischemia (reduced blood flow) in the brain, with reversible symptoms. Management is with antiplatelets and statins.
• Ischemic Stroke: Blood flow to the brain is blocked. Treatment with tissue plasminogen activator (tPA) within a 3-4.5 hour window from onset, and anticoagulants.
• Hemorrhagic Stroke: Blood vessel in the brain ruptures. Management focuses on surgery and blood pressure control.
• Nursing Interventions: Monitoring intracranial pressure (ICP) (and for Cushing's triad: hypertension, bradycardia, irregular respirations), preventing aspiration, and maintaining respiratory function top priority.

Hematological Disorders

• Iron Deficiency Anemia (IDA): Insufficient iron for hemoglobin production, leading to low RBC count. Causes include inadequate dietary intake, increased iron demand (pregnancy, etc.), blood loss, or malabsorption.
• Anemia in Renal Disease: Decreased erythropoietin production by the kidneys leads to reduced RBC production in chronic kidney disease. Symptoms include fatigue and pallor. Treatment focuses on managing the underlying kidney disease and providing erythropoiesis-stimulating agents (ESAs).
• Aplastic Anemia: Bone marrow fails to produce enough blood cells (RBCs, WBCs, and platelets). Treatment often involves bone marrow transplant or immunosuppressive therapy.
• Folic Acid Deficiency Anemia: Insufficient folic acid (vitamin B9) for DNA synthesis, resulting in large, immature RBCs. Causes include poor dietary intake, increased demand, malabsorption, and certain medications.
• Vitamin B12 Deficiency Anemia: A deficiency of vitamin B12, crucial for DNA synthesis and myelin synthesis. This can cause neurological symptoms. Causes include, pernicious anemia (autoimmune destruction of intrinsic factor), dietary deficiency, malabsorption and certain medications.

Coagulation Disorders

• Coagulation disorders: Include conditions like thrombocytopenia (low platelet count), hemophilia, vitamin K deficiency, disseminated intravascular coagulation (DIC) and Von Willebrand Disease (vWD). Treatment depends on the specific disorder, but often involves managing underlying causes, and preventing bleeding. Management includes platelet transfusions and factor replacement therapies.

Laboratory Values

• Intracranial Pressure (ICP): Measured invasively; normal range 5-15 mmHg. Elevated ICP is a critical finding.
• White Blood Cell Count (WBC): Normal range 4,000-10,000/mm³. Used to assess infection, inflammation, or immuno-function.
• Hemoglobin (Hgb): Normal range 12-17 g/dL. Measures oxygen-carrying capacity of the blood.
• Hematocrit (Hct): Normal range 36-51%. Indicates the proportion of red blood cells (RBC) in blood.
• Platelets: Normal range 150,000-350,000/mm³. Evaluates blood's clotting ability and its low value can indicate various conditions.

Test your knowledge on the fundamentals of lumbar punctures, including their primary purpose, normal cerebrospinal fluid characteristics, and diagnostic capabilities. This quiz covers key parameters vital for analyzing cerebrospinal fluid and interpreting abnormalities.