CT before lumbar puncture: Difference between revisions

Revision as of 23:38, 1 March 2011

LP without CT is likely safe if:

If none of the above, chance of normal ct is 97%, none of the patients herniated
CT before LP often results in longer average delay to abx

Source:

NEJM 2001; 345; 1727-33

Authors:

@@ Line 1: / Line 1: @@
-% had mass effect on ct
+LP without CT is likely safe if:
-- pts with abnormal cts:
---- age >60,immunecompromised, cns dz, sz within one wk, aloc, unable to answer questions, unable to follow
-commands, gaze palsy, abnrm visual fields, arm/ leg
+* History
+* Age < 60
+* Not immunocompromised
+* No history of CNS disease
+* No seizure within 1 week of presentation
+* Physical Exam
+* No ALOC
+* No inability to answer two consecutive questions successfully
+* No inability to follow two consecutive commands successfully
+* No gaze palsy
+* No abnormal visual fields
+* No facial palsy
+* No arm drift
+* No leg drift
+* No abnormal language
-drift, abnrml speech.
-- features not assoc with abnormal ct- race,
-insurance, htn, h/o parameningeal dz like otitis/
+* If none of the above, chance of normal ct is 97%, none of the patients herniated
+* CT before LP often results in longer average delay to abx
-sinusitis
-- if none of the above, chance of normal ct is 97%
-- even if do lp with mildly abnormal ct, none had
+Source:
-brain herniation
-- ct before lp resulted in longer ER stay and delay in
-abx
-- if no abnormal findings, neg predictive value is 97% - so don't need ct routinely
-- if have abnormal finding, abx first, then ct then lp
-/2/09 PANI
+NEJM 2001; 345; 1727-33