CONTROVERSY

Diagnosis

When to do a lumbar puncture

F A I Riordan¹, A J Cant²

¹ Department of Child Health, Birmingham Heartlands and Solihull NHS Trust (Teaching), Birmingham, UK
² Paediatric Immunology and Infectious Diseases Unit, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne, UK

Correspondence to:
Correspondence to:
Dr F A I Riordan, Department of Child Health, Birmingham Heartlands Hospital, Bordeseley Green East, Birmingham B9 5SS, UK;
Riordaa@heartsol.wmids.nhs.uk

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If you suspect meningitis, unless there is a specific contraindication

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Keywords: lumbar puncture; meningitis

Abbreviations: CT, computed tomography; PCR, polymerase chain reaction

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

Lumbar puncture has long been a key investigation. The "classical signs" of meningitis are often absent in infants in the first year of life. Lumbar puncture is thus advocated for any infant who is drowsy or ill, without awaiting the development of meningeal signs.¹ Concerns about the perceived dangers of lumbar puncture² and a suggestion that it has little diagnostic value in meningococcal disease³ have led to fewer lumbar punctures being performed.⁴ Some experts have expressed concerns that not enough lumbar punctures are being performed, since the consequences of missing meningitis may be disastrous.⁵ A review of the indications for lumbar puncture is thus timely, and papers in this issue by McMaster and colleagues⁶ and Carroll and Brookfield⁷ contribute to this debate.

Critical questions include:

• What are the benefits of lumbar puncture in suspected meningitis?
  
• What are the contraindications to lumbar puncture?
  
• How is meningitis diagnosed and treated if . . . [Full text of this article]

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Relevant Article

Atoms

Harvey Marcovitch
Arch. Dis. Child. 2002 87: 173. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Joffe, A. R. (2007). Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: A Review. J Intensive Care Med 22: 194-207 [Abstract]  
• Ellenby, M. S., Tegtmeyer, K., Lai, S., Braner, D. A.V. (2006). Videos in clinical medicine. Lumbar puncture.. NEJM 355: e12-e12  
• Garges, H. P., Moody, M. A., Cotten, C. M., Smith, P. B., Tiffany, K. F., Lenfestey, R., Li, J. S., Fowler, V. G. Jr, Benjamin, D. K. Jr (2006). Neonatal Meningitis: What Is the Correlation Among Cerebrospinal Fluid Cultures, Blood Cultures, and Cerebrospinal Fluid Parameters?. Pediatrics 117: 1094-1100 [Abstract] [Full Text]  
• Chin, R F M, Neville, B G R, Scott, R C (2005). Meningitis is a common cause of convulsive status epilepticus with fever. Arch. Dis. Child. 90: 66-69 [Abstract] [Full Text]  
• Welch, S B, Nadel, S (2003). Treatment of meningococcal infection. Arch. Dis. Child. 88: 608-614 [Abstract] [Full Text]  
• El Bashir, H, Laundy, M, Booy, R (2003). Diagnosis and treatment of bacterial meningitis. Arch. Dis. Child. 88: 615-620 [Abstract] [Full Text]  
• Finn, A (2003). More lumbar punctures, please!. Arch. Dis. Child. 88: 177-177 [Full Text]  
• Isaacs, D, Kneen, R, Solomon, T, Appleton, R (2003). LP and Glasgow coma score * Authors' reply. Arch. Dis. Child. 88: 177-177 [Full Text]  

eLetters:

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LP controversies

Denis G Gill

ADC Online, 10 Oct 2002 [Full text]