title: Successful lumbar puncture with Taylor's approach for the diagnostic workup of meningitis in a patient with Ankylosing spondylitis.
abstract: Meningitis and encephalitis are the neurological emergencies. As the clinical findings lack specificity, once suspected, cerebrospinal fluid (CSF) analysis should be performed and parenteral antimicrobials should be administered without delay. Lumbar puncture can be technically challenging in patients with ankylosing spondylitis due to ossification of ligaments and obliteration of interspinous spaces. Here, we present a case of ankylosing spondylitis where attempts for lumbar puncture by conventional approach failed. CSF sample was successfully obtained by Taylor's approach.
authors.affiliation: Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Gentle Sunder
authors.initials: GS
authors.lastname: Shrestha
authors.affiliation: Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Subhash Prasad
authors.initials: SP
authors.lastname: Acharya
authors.affiliation: Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Niraj
authors.initials: N
authors.lastname: Keyal
authors.affiliation: Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Hem Raj
authors.initials: HR
authors.lastname: Paneru
authors.affiliation: Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Pramesh Sunder
authors.initials: PS
authors.lastname: Shrestha
keywords: Ankylosing spondylitis; Taylor's approach; difficult lumbar puncture; meningitis