SUMMARY:Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Our goal with this review was to describe our techniques for lumbar puncture in the difficult patient, with emphasis on using fluoroscopy in the obese patient and to suggest maneuvers that might make the procedure easier. Combining our experience from performing these procedures on an obese population, we would like to share our tips, especially with trainees early in their career. ABBREVIATIONS:BMI ϭ body mass index; IIH ϭ idiopathic intracranial hypertension; LP ϭ lumbar puncture

A rare radiological to pathological correlation of astroblastoma is presented in which the evolving hematoma, as observed on magnetic resonance imaging scans, complicated the radiographic diagnosis of this lesion. The clinical, radiographic, and pathological features of astroblastomas, as well as the natural history of these rare glial neoplasms, are reviewed. This case illustrates the capacity of astroblastomas to hemorrhage, disguising the classic radiographic findings typical of this glial neoplasm.