RCP Medicine Podcast Episode 7: To LP or not LP
May 24, 2019
Hussain Bashir, a respiratory registrar in the KSS deanery, contributes clinical insight on acute medicine. They dissect a sudden severe headache case and debate CT versus lumbar puncture. Conversation covers CT timing, xanthochromia, the Ottawa SAH rule, patient impact of LPs, and when to pursue alternative diagnoses like intracranial hypertension.
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CT Within Six Hours Is Highly Reliable
- Modern CT within 6 hours is highly sensitive for subarachnoid hemorrhage and often sufficient.
- Lumbar puncture mainly helped when older CT tech missed small bleeds or after six hours.
Clinician Caution Drives Many LPs
- Hussain describes frequent practice where normal CTs still lead to routine LPs driven by clinician uncertainty.
- He notes the patient burden of repeated warnings about possible brain bleed and logistics of arranging LPs.
Weigh LP Benefits Against Harms
- Before performing an LP, consider test sensitivity and patient impact including post-LP headache risk.
- Explain risks and avoid unnecessary delays that keep patients admitted for days awaiting the procedure.