Cranial CT scanning should be obtained before lumbar puncture in all patients with suspected SAH in order to diagnose obvious intracranial bleeding or any significant intracranial mass effect that might be present in awake and alert SAH patients with a normal neurologic examination.
Lumbar Puncture (LP) Interpretation of Cerebrospinal Fluid
The following measures should be taken to help minimize complications of lumbar puncture:
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Explain the procedure, benefits, risks, complications, and alternative options to the patient or the patient’s representative, and obtain a signed informed consent
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Before performing the lumbar puncture, ensure that patients are hydrated so as to avoid a dry tap
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Never allow a lumbar puncture or a pre–lumbar puncture CT scan to delay administration of intravenous (IV) antibiotics; meningitis can usually be inferred from the cell count, antigen detection, or both
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Prophylactic bed rest after lumbar puncture has not been shown to be of benefit and should not be recommended.
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The overall risk of post dural puncture headache (PDPH) does not appear to be influenced by opening pressure, closing pressure, and volume of cerebrospinal fluid removed in instances of high-volume removal.