A lumbar puncture (LP) is contraindicated in the following scenarios:
- 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.
- 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.
- Patients with an epidural abscess.