Contraindications of a Lumbar Puncture

A lumbar puncture (LP) is contraindicated in the following scenarios:

1. Patients with bleeding diathesis, e.g. severe coagulopathy (INR >1.4) and thrombocytopenia (platelet <50 x 10⁹/L). If coagulopathy or thrombocytopenia is not corrected prior to the procedure, spinal hematomas resulting in spinal cord compromise may result.
2. Patients with increased intracranial pressure due to an intracranial lesion causing mass effect or significant cerebral oedema. In these circumstances, a LP may cause cerebral herniation.
3. Patients with an epidural abscess.