Meningitis: Neurological deterioration is uncommon after lumbar puncture.

Clinical bottom line (level 3a-)

  1. In patients with raised intracranial pressure, lumbar puncture carried complications in 0% to 5% of cases.
Archer : Canadian Medical Association Journal 1993; 148 (6): 961-965
Expires January 2003

The study

Systematic review of case reports, cohort studies or trials of
  • Patients: suspected acute meningitis
  • Intervention: CT before lumbar puncture
  • Outcome: death


    • Articles found in English using MEDLINE, 1965-1991 (search terms: not stated ) and bibliographies of retrieved studies and numerous standard texts were searched

    Selection criteria: as above
    Appraisal criteria: not stated
    Articles excluded if: not stated

    No studies were found to specifically assess utility of CT prior to lumbar puncture

    The evidence

    • Patients with increased intracranial pressure of any cause have a 0% to 5% complication rate.

    Comments

    1. Very unclear what data was assessed for this review.
    2. No direct evidence was presented, relating to the use of CT scanning .

    Citation

    1. Archer BD, : Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits. Canadian Medical Association Journal 1993; 148 (6): 961-965
    Contributor: Bob Phillips and Clare Wotton, January 1999
    Reviewer: Dirk Stengel

    Clinical Question.
    Patient patient with suspected meningitis
    Intervention or Exposure CT head scan prior to LP
    Outcome alter course of action, coning