What type of brain bleed is typically contraindicated for lumbar puncture due to the risk of herniation?

Intracerebral hemorrhage is associated with an increased risk of intracranial pressure and potential herniation if a lumbar puncture is performed. This type of bleed occurs within the brain tissue itself, often due to hypertension or vascular malformations. In the case of an intracerebral hemorrhage, the accumulation of blood can create a mass effect, leading to displacement of brain structures. Performing a lumbar puncture in this scenario can exacerbate the situation by allowing cerebrospinal fluid to escape, which reduces pressure in the cranial cavity and may lead to a downward shift of brain matter, causing herniation.

In contrast, while subdural and epidural hemorrhages also pose risks, the mechanisms and urgency differ. Subarachnoid hemorrhage does carry significant risks as well but is specifically associated with distinct clinical scenarios and management strategies. Therefore, intracerebral hemorrhage is uniquely associated with the contraindication for lumbar puncture due to the immediate and critical risk of herniation.