Lumbar Puncture: Risk of Brain Herniation.

Hey Doc,

I've had two MRI's which have shown multiple brain lesions, with the second MRI showing additional lesions since the first one. My Spinal MRI came back clear as did my EEG and other evoked potential (visual, auditory and the other one where they put electrodes on your ankle and hip). My neurologist wants me to get a Lumbar Puncture, however, I'm fearful of having a brain herniation as I believe I have some symptoms of raised intracranial pressure, including a low resting heart rate (Bradycardia?) of 52 bpm, a weak pulse and high blood pressure which is now controlled. I'm also concerned as my blood pressure is 120/60 and there is a large gap between the systolic and diastolic which I've read may indicate increased ICP.

I've spoken to my neurologist and he states that there is nothing on my MRI which indicates raised ICP. I also have raised ACE levels which have come back as 67, 97 and 85 in that order. I also often feel pressure in my head which is when the symptoms occur, it feels as if fluid is building up in my head.

What are the risks involved with a lumbar puncture considering the above information?

Thank you for your help.

[Shazia Alam, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

Many people may have a low resting heart rate, therefore this is not necessarily specific for increased intracranial pressure.  This also is the same for the large gap between your systolic and diastolic blood pressures.   There are other ways to evaluate for increased ICP on your MRI such as looking for space between certain brain structures which helps us tell if there is swelling.  

It would be higly recommended to have your LP done.  If you are very concerned still you can have your neurologist take off only the bare minimum fluid required to evaluate your lesions.  Your body will make the same amount of CSF taken off within an hour.  

Hope this information was helpful.  

[Janitor]

Anyone have any insight regarding my question?