CT before lumbar puncture: Difference between revisions

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LP without CT is likely safe if:
{{CT before LP}}


# History
==See Also==
## Age < 60
*[[Lumbar Puncture]]
## 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
==References==
<references/>


==Source==
[[Category:Neurology]]
NEJM 2001; 345; 1727-33
[[Category:Procedures]]
 
[[Category:Radiology]]
[[Category:Neuro]]
[[Category:Procedure]]

Latest revision as of 16:50, 25 June 2016

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

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

See Also

References

  1. Computed Tomography of the Head before Lumbar Puncture in Adults with Suspected Meningitis. NEJM 2001; 345; 1727-33
  2. Emergency Radiology: Case Studies Schwartz