Is a bulging fontanelle a contraindication lumbar puncture?

Bulging fontanelle and fever alone are not always sufficient indication for lumbar puncture. LP is mandatory if these signs are complicated by febrile seizure, toxemia, rash, nuchal rigidity or other signs of meningitis.

Why does a meningitis fontanelle bulge?

A tense or bulging fontanelle occurs when fluid builds up in the brain or the brain swells, causing increased pressure inside the skull. When the infant is crying, lying down, or vomiting, the fontanelles may look like they are bulging.

Is a bulging fontanelle fever normal?

Acquired hydrocephalus Infections: An infection in the brain or spinal cord, such as bacterial meningitis, may cause a bulging fontanel. This is more likely when the baby has a fever. Injuries: Brain and spinal cord injuries, including blows to the head, may cause swelling in the brain.

What are the contraindications for lumbar puncture?

Absolute contraindications for performing a LP include infected skin over the puncture site, increased intracranial pressure (ICP) from any space-occupying lesion (mass, abscess), and trauma or mass to lumbar vertebrae.

When do you need LP for meningitis?

In conclusion, early lumbar puncture rapidly confirms or excludes bacterial meningitis in most cases and should be performed when meningitis is suspected unless there is a specific contraindication (signs of cerebral herniation, signs suggesting a disease other than meningitis or shock).

What are the complications of lumbar puncture?

Risks

Post-lumbar puncture headache. Around 25% of people who have undergone a lumbar puncture develop a headache afterward due to a leak of fluid into nearby tissues.
Back discomfort or pain. You may feel pain or tenderness in your lower back after the procedure.
Bleeding.
Brainstem herniation.

When should I worry about a bulging fontanelle?

A bulging fontanel is an emergency. It can be a sign of pressure rising inside the skull which may result in damage to the baby’s developing brain. If your child is experiencing this symptom, seek medical attention immediately.

When should I worry about my Fontanelle?

Remember, there’s no need to be overly concerned about your baby’s fontanelle — or even to be overly protective of it — but if you notice that baby’s soft spot appears very sunken, it’s important that you contact your pediatrician right away.

What happens if too much CSF is drained?

It is possible that the puncture of the ventricle or the opening of the dura will result in an intracranial hemorrhage. It is possible that if too much CSF is removed from the ventricles, either during a drainage procedure or when the ventricle is first punctured, the ventricle may collapse and occlude the catheter.

What level should a lumbar puncture be?

Therefore a lumbar puncture is generally performed at or below the L3-L4 interspace. As a general anatomical rule, the line drawn between the posterior iliac crests often corresponds closely to the level of L3-L4. The interspace is selected after palpation of the spinous processes at each lumbar level.

Can a 7 month old have a bulging fontanelle?

A previously healthy 7-month-old male presented to the emergency department with fever and a bulging anterior fontanelle. A computed tomographic scan of the head suggested mild communicating hydrocephalus.

What are the common causes of bulging fontanelle?

Bulging Fontanelle: Common Benign Causes 1 Supine (or Trendelenburg) Position. 2 Coughing. 3 Vomiting. 4 Crying. 5 Recent Vaccinations have also been associated with bulging fontanelle, but no causal link known and often determined after ruling out badness…

Is the CSF count normal after a lumbar puncture?

Lumbar puncture was performed, which revealed a normal cerebrospinal fluid (CSF) cell count and glucose concentration, but a markedly elevated opening pressure. DNA polymerase chain reaction for herpes simplex virus performed on CSF was negativ […]

Is it normal for a fontanelle to be above the skull?

The fontanelle should normally be slightly sunken relative to the upper table of the skull. A fontanelle that is even with the upper level of the skull or above it is abnormal. Pulsations are normal – usually represent peripheral pulses.

Is a bulging fontanelle a contraindication lumbar puncture? Bulging fontanelle and fever alone are not always sufficient indication for lumbar puncture. LP is mandatory if these signs are complicated by febrile seizure, toxemia, rash, nuchal rigidity or other signs of meningitis. Why does a meningitis fontanelle bulge? A tense or bulging fontanelle occurs when fluid…