Template:CT before LP: Difference between revisions
(Created page with "'''LP without CT is likely safe if:<ref>*NEJM 2001; 345; 1727-33</ref>''' *History **Age < 60 **Not immunocompromised **No history of CNS disease **No seizure within 1 week o...") |
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*Physical Exam | *Physical Exam | ||
**No ALOC | **No ALOC | ||
**Ability to answer two consecutive questions successfully | ***Ability to answer two consecutive questions successfully | ||
**Ability to follow two consecutive commands successfully | ***Ability to follow two consecutive commands successfully | ||
**Normal [[neurologic exam]] | **Normal [[neurologic exam]] | ||
Revision as of 22:04, 17 November 2014
LP without CT is likely safe if:[1]
- History
- Age < 60
- Not immunocompromised
- No history of CNS disease
- No seizure within 1 week of presentation
- Physical Exam
- No ALOC
- Ability to answer two consecutive questions successfully
- Ability to follow two consecutive commands successfully
- Normal neurologic exam
- No ALOC
If none of the above, chance of normal ct is 97%; none of the patients herniated
CT findings that prohibit LP:[2]
- Midline shift
- Unequal pressures between the 3 cerebral compartments (left/right supretentorial compartments, posterior fossa)
- Intracerebral masses not causing midline shift
- Obstructive Hydrocephalus
- Enlargement of ventricles prox to lesions and normal ventricles distal (especially 4th ventricle)
- Basilar cisterns compressed
- Lateral/3rd ventricles may be small due to diffuse cerebral edema or enlarged due to obstr. hydroceph. +/- shift
- Posterior fossa mass
- Displacement/compression of 4th ventricle