Difference between revisions of "CT before lumbar puncture"

(Created page with "5% had mass effect on ct - pts with abnormal cts: --- age >60,immunecompromised, cns dz, sz within one wk, aloc, unable to answer questions, unable to follow commands, gaze pa...")
 
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5% had mass effect on ct
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LP without CT is likely safe if:
  
- pts with abnormal cts:
 
  
--- age >60,immunecompromised, cns dz, sz within one wk, aloc, unable to answer questions, unable to follow
 
  
commands, gaze palsy, abnrm visual fields, arm/ leg
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* History
 +
* Age < 60
 +
* Not immunocompromised
 +
* No history of CNS disease
 +
* No seizure within 1 week of presentation
 +
* Physical Exam
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* No ALOC
 +
* No inability to answer two consecutive questions successfully
 +
* No inability to follow two consecutive commands successfully
 +
* No gaze palsy
 +
* No abnormal visual fields
 +
* No facial palsy
 +
* No arm drift
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* No leg drift
 +
* No abnormal language
 +
  
drift, abnrml speech.
 
  
- features not assoc with abnormal ct- race,
 
  
insurance, htn, h/o parameningeal dz like otitis/
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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
sinusitis
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- if none of the above, chance of normal ct is 97%
 
  
- even if do lp with mildly abnormal ct, none had
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Source:
 
 
brain herniation
 
 
 
- ct before lp resulted in longer ER stay and delay in
 
 
 
abx
 
 
 
- if no abnormal findings, neg predictive value is 97% - so don't need ct routinely
 
 
 
- if have abnormal finding, abx first, then ct then lp
 
 
 
 
  
7/2/09 PANI
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NEJM 2001; 345; 1727-33
  
  

Revision as of 23:38, 1 March 2011

LP without CT is likely safe if:


  • History
  • Age < 60
  • Not immunocompromised
  • No history of CNS disease
  • No seizure within 1 week of presentation
  • Physical Exam
  • No ALOC
  • No inability to answer two consecutive questions successfully
  • No inability to follow two consecutive commands successfully
  • No gaze palsy
  • No abnormal visual fields
  • No facial palsy
  • No arm drift
  • No leg drift
  • 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