Misdiagnosis Arising Out Of Failure To Do Lumbar Puncture

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Misdiagnosis Arising Out Of Failure To Do Lumbar Puncture

Misdiagnosis often occurs when physicians cut corners, jump to conclusions, ignore symptoms, and/or fail to rule out less common causes of a given symptom complex.  Frequently, the mistake is as simple as performing a key test when a patient’s presentation is consistent with a life-threatening condition. We see this time and time again with lumbar puncture.  Today, I want to discuss the usefulness of lumbar puncture in two contexts: subarachnoid hemorrhage (SAH) and meningitis.

Lumbar puncture is a safe, inexpensive test that involves using a spinal needle to draw cerebrospinal fluid (CSF) from the patient.  The fluid is then tested for signs of infection or bleeding that might explain the patient’s symptoms.  Though lumbar puncture, also called an LP or a spinal tap, seems scary, it actually is very safe with few reported complications when used in properly selected patients.  In fact, complications are so rare that experts describe them as merely “theoretical.”

In the case of SAH, LPs are used to detect blood in the CSF that might reflect bleeding in the brain.  Treatment of SAH is time sensitive; the earlier that a diagnosis is made, the better the outcomes tend to be.  CT imaging is used to evaluate for SAH.  However, a recent report in the Annals of Emergency Medicine reports that a CT scan alone may miss up to 20% of SAHs.  Thus, LP must still be performed to rule out this potentially deadly condition when patients present with a symptom complex that is consistent with the diagnosis.

For meningitis, LP is necessary to make the diagnosis and also to differentiate viral from bacterial forms of the disease.  The overall incidence of meningitis is on the rise with an increase in procedures that breach the blood-brain barrier separating the central nervous system from the rest of the body.  Treatment of bacterial meningitis, like SAH, is time sensitive.  Any delay in treatment allows the condition to progress to death or severe complications, like brain injury, permanent neurologic deficits or amputation.

When a physician skips an LP in the face of a symptom complex that is consistent with SAH or meningitis, this is dangerous and it puts the patient at a preventable risk of harm.  If a physician takes a chance with the patient’s life or well-being, and harm results, a medical negligence claim may exist under Ohio law.  Misdiagnosis that results from unnecessary corner cutting in the face of a potentially life-threatening condition equates to medical malpractice.

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By David Kulwicki|2022-02-17T23:31:10+00:00May 2nd, 2013|Misdiagnosis|Comments Off on Misdiagnosis Arising Out Of Failure To Do Lumbar Puncture

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