Difference between revisions of "CT before lumbar puncture"

(Text replacement - "==Source== <references/>" to "==References== <references/>")
 
(15 intermediate revisions by 3 users not shown)
Line 1: Line 1:
LP without CT is likely safe if:
+
{{CT before LP}}
  
 +
==See Also==
 +
*[[Lumbar Puncture]]
  
 +
==References==
 +
<references/>
  
* History
+
[[Category:Neurology]]
* Age < 60
+
[[Category:Procedures]]
* Not immunocompromised
+
[[Category:Radiology]]
* 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
 
 
 
 
 
 
 
 
 
[[Category:Neuro]]
 

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