Difference between revisions of "CT before lumbar puncture"

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LP without CT is likely safe if:
 
LP without CT is likely safe if:
  
 
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# History  
 
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## Age < 60
* History  
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## Not immunocompromised
* Age < 60
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## No history of CNS disease
* Not immunocompromised
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## No seizure within 1 week of presentation
* No history of CNS disease
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# Physical Exam
* No seizure within 1 week of presentation
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## No ALOC
* Physical Exam
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## No inability to answer two consecutive questions successfully
* No ALOC
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## No inability to follow two consecutive commands successfully
* No inability to answer two consecutive questions successfully
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## No gaze palsy
* No inability to follow two consecutive commands successfully
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## No abnormal visual fields
* No gaze palsy
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## No facial palsy
* No abnormal visual fields
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## No arm drift
* No facial palsy
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## No leg drift
* No arm drift
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## No abnormal language  
* No leg drift
 
* No abnormal language  
 
 
   
 
   
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If none of the above, chance of normal ct is 97%, none of the patients herniated
  
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CT before LP often results in longer average delay to abx
  
 
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==Source==
* If none of the above, chance of normal ct is 97%, none of the patients herniated
 
* CT before LP often results in longer average delay to abx
 
 
 
 
Source:
 
 
 
 
NEJM 2001; 345; 1727-33
 
NEJM 2001; 345; 1727-33
 
 
 
  
 
[[Category:Neuro]]
 
[[Category:Neuro]]
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[[Category:Procedure]]

Revision as of 06:21, 28 March 2011

LP without CT is likely safe if:

  1. History
    1. Age < 60
    2. Not immunocompromised
    3. No history of CNS disease
    4. No seizure within 1 week of presentation
  2. Physical Exam
    1. No ALOC
    2. No inability to answer two consecutive questions successfully
    3. No inability to follow two consecutive commands successfully
    4. No gaze palsy
    5. No abnormal visual fields
    6. No facial palsy
    7. No arm drift
    8. No leg drift
    9. No abnormal language

If none of the above, chance of normal ct is 97%, none of the patients herniated

CT before LP often results in longer average delay to abx

Source

NEJM 2001; 345; 1727-33