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Neurología Mancha-Centro

Servicio de Neurología del Area Mancha Centro - Hosp. General Mancha Centro y Hosp. General de Tomelloso

Blog de Neurologia Post New Entry


Posted by SANTI on October 4, 2014 at 6:00 PM


  La punción lumbar es una técnica que los neurólogos practicamos con frecuencia y consiste en la extracción de líquido cefalorraquídeo (LCR). Se realiza comúnmente en la cama de la habitación o en la camilla de exploración del box de urgencias. El procedimiento es parecido a algunas técnicas como la administración de anestesia epidural en el parto de las embarazadas. Se suele realizar acostado en posición de decúbito lateral con actitud fetal y las piernas flexionadas aunque tambíen puede realizarse en posición de sentado.

La punción se hace a nivel de la columna lumbar, en el espacio existente entre dos vértebras, tras desinfectar la zona y condiciones estériles, extrayéndose una muestra de LCR para ser analizado. A la altura donde se realiza ya no hay médula, sólo líquido y raíces nerviosas.

En ocasiones se administra anestesia local, aunque en la práctica habitual no se suele emplear ya que no es una técnica especialmente molesta por regla general, evitando así realizar dos pinchazos.

Durante la misma se puede notar una sensación de descarga eléctrica hacia una pierna, que es el resultado del contacto de la aguja con una raíz nerviosa, próxima al líquido que queremos obtener.

Figura 1

Figura 2


   El líquido cefalorraquídeo se encuentra rodeando al cerebro y la médula espinal, en íntimo contacto, por lo que se altera en muchos procesos patológicos que afectan a éstos. Su estudio resulta fundamental para el estudio de muchas enfermedades neurológicas potencialmente graves (hemorragia, infecciones, enfermedades inflamatorias, procesos oncológicos.... ) que afectan al sistema nervioso. Permite, asimismo, conocer la presión a la que se encuentra este líquido, administrar medicaciones o contrastes y es una manera de tratar algunos trastornos.

Figura 3.


    A pesar de la correcta realización de la técnica pueden aparecer efectos secundarios específicos del procedimiento. Uno de los más frecuentes es la aparición de dolor de cabeza, que aparece de forma característica al pasar de estar tumbado a sentarse o levantarse y que se cree puede ser debido a la disminución de la presión intracraneal por la extracción del líquido, siendo las maniobras más habituales para prevenirlo el reposo en cama y la ingesta de abundantes líquidos durante las horas siguientes a la punción. Si apareciera, generalmente desaparece en pocos días con el reposo estricto y la administración de analgésicos. Las infecciones por esta técnica son muy poco frecuentes al realizarse en condiciones de esterilidad. Otras complicaciones muy poco frecuentes son hematomas locales en el sitio de la punción, apareciendo con mayor frecuencia en pacientes con enfermedades hematológicas o tratados con fármacos anticoagulantes. De forma excepcional se han descrito hematomas intracraneales secundarios a hipotensión de LCR, así como herniación transtentorial que es una complicación grave y que puede aparecer en pacientes con algunos procesos intracraneales como grandes masas que por medio de la historia clínica, la exploración neurológica y las pruebas complementarias habrán de descartarse previamente.


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