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Evaluation of CSF is essential for the diagnosis of suspected meningeal infection, subarachnoid hemorrhage, leptomeningeal neoplastic disease, and noninfectious meningitis. Relative contraindications to LP include local skin infection in the lumbar area, suspected spinal cord mass lesion, and a suspected intracranial mass lesion. Any bleeding diathesis should also be corrected prior to performing LP to prevent the possible occurrence of an epidural hematoma. A functional platelet count >50,000/μL and an international normalized ratio (INR) <1.5 are advisable to perform LP safely.
In pts with an altered level of consciousness, focal neurologic deficits, or evidence of papilledema, an imaging study should generally be obtained prior to performing LP.