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Lumbar puncture should not be performed in the following situations:
Idiopathic (unidentified cause) increased intracranial pressure (ICP)
Rationale: lumbar puncture in the presence of increased ICP may cause uncal herniation
Exception: therapeutic use of lumbar puncture to reduce ICP
Precaution
CT brain is advocated by some, especially in the following situations
Age >65
Reduced GCS
Recent history of seizure
Focal neurological signs
Ophthalmoscopy for papilledema
Bleeding diathesis
Coagulopathy
Decreased platelet count (<50 x 109/L)
Infections
Skin infection at puncture site
Sepsis
Abnormal respiratory pattern
Hypertension with bradycardia and deteriorating consciousness
Vertebral deformities (scoliosis or kyphosis), in hands of an inexperienced physician
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