Rethinking lumbar puncture safety: pathophysiology, diagnostic uncertainty, and research gaps in herniation risk

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F61383082%3A_____%2F25%3A00001577" target="_blank" >RIV/61383082:_____/25:00001577 - isvavai.cz</a>

Result on the web

<a href="https://pubmed.ncbi.nlm.nih.gov/40804214/" target="_blank" >https://pubmed.ncbi.nlm.nih.gov/40804214/</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1007/s13760-025-02866-0" target="_blank" >10.1007/s13760-025-02866-0</a>

Result language

angličtina

Original language name

Rethinking lumbar puncture safety: pathophysiology, diagnostic uncertainty, and research gaps in herniation risk

Original language description

Lumbar puncture (LP) is a key diagnostic and therapeutic tool, yet concerns persist about its potential to induce brain herniation, especially in patients with elevated intracranial pressure (ICP). Despite ongoing debate, precise risk factors and pathophysiological mechanisms remain unclear. Objective: This systematic review aims to examine the risk of cerebellar and paradoxical brain herniation following LP, evaluate the current evidence regarding its incidence, and discuss the implications for clinical practice as well as show the gaps in research. Methods: Following PRISMA guidelines, a systematic literature review was conducted using the PubMed (MEDLINE) database. Studies from 1990 to 2024 focusing on bacterial meningitis, idiopathic intracranial hypertension, post-surgical states, and other conditions associated with elevated ICP were included. Results: LP-related herniation was reported in diverse clinical settings, with cerebellar herniation primarily seen in bacterial meningitis and idiopathic intracranial hypertension. Herniation onset varied from minutes to days post-LP. While cranial CT is widely used for risk assessment, its predictive accuracy is debated. Conclusions: Although LP is relatively safe, herniation risk is highly context-dependent. Clinicians should integrate clinical, radiological, and pathophysiological factors in decision-making. Further research is needed to refine predictive models and establish evidence-based guidelines for high-risk patients.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30103 - Neurosciences (including psychophysiology)

Project

—

Continuities

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2025

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Acta Neurologica Belgica

ISSN

0300-9009

e-ISSN

—

Volume of the periodical

2025

Issue of the periodical within the volume

Aug 2025

Country of publishing house

BE - BELGIUM

Number of pages

12

Pages from-to

1-12

UT code for WoS article

001549118000001

EID of the result in the Scopus database

2-s2.0-105013339543