LEADING ARTICLE

Lumbar puncture

The role of lumbar puncture in suspected CNS infection—a disappearing skill?

R Kneen, T Solomon, R Appleton

The Roald Dahl EEG Unit, Department of Neurology, Royal Liverpool Children’s Hospital (Alder Hey), Liverpool L12 2AP, UK

Correspondence to:
Correspondence to:
Dr Appleton;
Richard.Appleton@RLCH-TR.NWEST.NHS.UK

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Declining use of lumbar puncture may be detrimental to patient care

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Keywords: lumbar puncture; meningitis; encephalitis

The first 150 words of the full text of this article appear below.

Introduced by Quincke in 1891 to diagnose and treat tuberculous meningitis, lumbar puncture (LP), has since been used extensively in the investigation of many neurological conditions.¹ Cerebrospinal fluid (CSF) analysis and culture is the definitive method of diagnosing central nervous system (CNS) infections and, until the late 1970s, all or most patients admitted with suspected CNS infection in Western countries underwent LP.² In many developing countries this remains the practice. However, in the West the use of LP has declined over the last 20 years, primarily because of increasing anxiety that the procedure may precipitate cerebral herniation. In this paper we review the reasons for the declining use of LP and examine whether its usage is now so infrequent that it may be detrimental to patient care.

It has been recognised since the early 1960s that raised intracranial pressure (ICP) is a serious complication of acute bacterial meningitis.³ . . . [Full text of this article]

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eLetters:

Read all eLetters

More lumbar punctures, please!

Adam Finn

ADC Online, 6 Sep 2002 [Full text]

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Defer and practise

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Author's reply

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ADC Online, 1 Oct 2002 [Full text]