Under Pressure - Do we always need a CT before LP?

Hi all,

If you read this blog, I’m sure you are also reading the amazing St Emlyn’s blog as well. If not, get over there ASAP!

Shameless self promotion alert: We have only just gone and hit the top spot on the LITFL review! @EMManchester ‘s plot for world domination continues apace….

I am honoured to be part of the team for St Emlyn’s, and as such have started posting over there.

I am reluctant to abandon this blog though, and have a few ideas for it circulating – stuff that is a too frivolous, controversial etc. for the respectable physicians over at St Emlyn’s.

Watch this space.

In the mean time,  here is a quick presentation I prepared for a recent teaching session. Can we really cause brain herniation with a LP needle? Do we need to CT everyone first?

(I make no apologies for the unpolished nature of this stuff, it may or may not have been prepared at the last minute/in front of the new series of Homeland/while holding the baby)

Cheers all,

Gareth

References:

Why does tonsillar herniation not occur in idiopathic intracranial hypertension? Salman M. 1999

Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits. Archer BD. 1993

Cerebral Herniation during bacterial meningitis in children. Rennick et al. 1993

Cranial computed tomography before lumbar puncture: a prospective clinical evaluation. Gopal et al. 1999

Would be wrong not to credit Dr Scott Weingart of EMCRIT fame, who’s Crashing Patient website as a much more detailed review of the whole subject.