SynthesisActa neurologica Belgica2026
Rethinking lumbar puncture safety: pathophysiology, diagnostic uncertainty, and research gaps in herniation risk.
Synthesis in Acta neurologica Belgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundLumbar 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.
objectiveThis 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.
methodsFollowing 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.
resultsLP-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.
conclusionsAlthough 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.
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