Article Text

ROLE OF LUMBAR PUNCTURE IN CHILDREN WITH ENCEPHALITIS: KK HOSPITAL EXPERIENCE
  1. W K M Liew1,
  2. J T Y Wong1,
  3. H K Phuah1
  1. 1Neurology Service, Department Of Paediatric Medicine, KK Hospital, Singapore, Singapore

Abstract

Introduction Encephalitis, a common paediatric neurological disease, presents with a combination of headache, fever and altered level of consciousness. Many viruses and bacteriae have been implicated. Lumbar puncture (LP) is routinely done as part of the initial work-up or later in the course of illness, if there are initial contraindications, to determine the exact causative agent. LP, though a safe procedure, has its own risk. We aim to review the practice and management of encephalitis in our department and look at the role and safety of LP in these patients.

Method We conducted a retrospective study of all patients who were treated for encephalitis in our hospital between Jan 2001 to Dec 2003. Data was collected on the demographics, timing of LP, etiologic agent identified, adverse effects of LP, and management of patients including the antimicrobials used and their duration.

Results Twelve patients were treated for encephalitis during the period. Median age of presentation was 4.1 years (range 0.2 to 11.8 yrs). LP was performed in all patients and was delayed up to 5 days after admission in some patients. Nine (75%) of the patients had abnormal CSF fluid analyses with pleiocytosis and elevated protein levels. Mycoplasma was identified in 4 (33%) of these patients. There were no adverse outcomes after LP. All patients were covered with intravenous acyclovir and ceftriaxone and the duration of treatment was guided by CSF results.

Conclusion LP is a safe and important diagnostic tool in the management and treatment of paediatric patients with encephalitis.

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