Background: Lumbar punctures (LPs) are common among hospitalized patients and many institutions have implemented a hospital medicine procedure services (HMPS) to perform these routine bedside procedures. Most clinicians learn to perform this procedure using the midline (ML), landmark-guided approach which involves palpation of the lumbar spine but this technique is associated with failure rates as [...]

Case Presentation: This case report outlines the case of a 76 year-old male who presented with bacterial meningitis secondary to an infected intrathecal baclofen pump, but initial lumbar puncture cerebrospinal fluid (CSF) did not demonstrate pleocytosis. Patient endorsed worsening headache, vomiting, and bilateral lower extremity weakness 6 days prior to admission. He was immediately started [...]

Case Presentation: A 77 year-old female without significant history presented with six months of urinary incontinence, six weeks of progressive confusion and falls, and one day of decreased speech and poor appetite. During two recent hospitalizations for acute encephalopathy, imaging revealed a frontal lobe meningioma, acoustic neuroma, and diffuse ventricular enlargement.On admission, the patient was [...]

Case Presentation: A 49-year-old woman with a history of alcohol use disorder, hypertension, asthma, obesity, and prior lacunar stroke presented to a different hospital with seizure-like activity, encephalopathy, and right gaze deviation. Additional collateral history noted a year of progressive cognitive, bladder, and ambulatory dysfunction, resulting in wheelchair dependence.On admission, she was diagnosed with urosepsis [...]