CT before lumbar puncture
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