Expert: Ronald Levy, M.D. - 12/5/2007

Question
My daughter is 24 yrs. and was in emergency room for possible meningitis. After 7 hrs the ER Dr. took it upon herself to do a spinal tap w/o consent.  She tried 4 times one after another and was unsuccessful. At that time a anesthesologist came & did it. Sholud 5 spinals been done at once. My daugter is still in hospital w/ Blood infection now and massive headaches. There outcome is severe sinunitis. Please help me.

Answer
First of all they shouldn't have done a tap without consent. As for doing 5 of them, if she never got into the subarachnoid space on the 4 attempts, then there is no damage related to the CSF (but of course I am sure she has pain around the tap site). With regard to the headache, generally when an ER doc does a tap he uses an 18G needle so patients are more likely to get a "spinal headache". In the case of suspected mennengitis they figure they have a headache already so this won't be much worse. When an anesthesiologist performs a spinal, they use a much smaller needle (25G) so the risk of headache is small. Was a tap indicated? My guess is yes if they were ruling out mennengitis. Should the doc have asked for help sooner? Again I would think yes. Is it unusual that she tried 4 times before asking for help? No, unfortunately it is not. If the anesthesiologist had tried from the beginning would they have gotten it on the first attempt? Not necessarily. While we certainly have more experience, we often also have to take multiple attempts. This is related to the curvature of the spine, obesity, palpable landmarks, age and how wide the space is where we place the needle.

What should you do now. If the diagnosis is severe sinusitis then your daughter should be evaluated by an anesthesiologist for a spinal headache. If it is, there are treatments. If not, then she should be evaluated by a neurologist for the cause for her headache.

Hope this helps,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston