I did my first lumbar puncture (see how to do a lumbar puncture) today. Well, sorta. I had a registrar supervise me and I sort of hit bone rather than get the subarachnoid space. As it turns out, I wasn't following the angle of the spinous processes right and he took over and adjusted and fiddled a bit and got it in the right space.
Ohwell. Anyway, it was a guy in his twenties who turned up with headache, photophobia, neck stiffness and a period of disorientation, vertigo and confabulation today. He had had a headache one week ago but that had settled on paracetamol. He also had a bit of a cough for the week and fevers up to 38 degrees centigrade and chills but no rigors. His headache returned with a vengeance today.
The CSF from the lumbar puncture was clear, not milky or cloudy. Microscopy revealed a small amount of red blood cells, no white blood cells and no bacteria on gram stain. Biochemistry on the CSF showed a slightly raised protein level and a normal glucose level. Together with a totally normal full blood count, it looked like this guy had viral meningitis.
He was discharged with lots of analgesia for his headache, was advised to take the week off work and to re-present back to the emergency department if any serious symptoms occur.