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To the Editor:—
In his recent review of the lumbar puncture (201:317, 1967), Dr. Eben Alexander, Jr., is characteristically gentle in pointing out its hazards in the presence of increased intracranial pressure. He might have gone further to show that with the development of other diagnostic tools the indications for lumbar puncture have diminished to the point where it is almost obsolete in the diagnosis of intracranial mass lesions.The lumbar puncture has secured a firm foothold in the folkways of medicine as a screening test to be performed whenever there is apparent malfunction of the nervous system. In many instances, the test is not considered complete unless the effect of jugular compression also is tried. However, I think most neurosurgeons will agree that the care of a patient harboring structural disease of the nervous system is often hampered or at least delayed by indiscriminate invasion of the subarachnoid
Wallman LJ. Lumbar Puncture and Brain Tumor. JAMA. 1967;201(12):982. doi:10.1001/jama.1967.03130120090036
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