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'''LP without CT is likely safe if:<ref> | '''LP without CT is likely safe if:<ref>Computed Tomography of the Head before Lumbar Puncture in Adults with Suspected Meningitis. NEJM 2001; 345; 1727-33</ref>''' | ||
*History | *History | ||
**Age < 60 | **Age < 60 | ||
**Not immunocompromised | **Not immunocompromised | ||
**No history of CNS disease | **No history of CNS disease | ||
**No seizure within 1 week of presentation | **No [[seizure]] within 1 week of presentation | ||
*Physical Exam | *Physical Exam | ||
**No | **No [[altered level of consciousness]] | ||
***Ability to answer two consecutive questions successfully | ***Ability to answer two consecutive questions successfully | ||
***Ability to follow two consecutive commands successfully | ***Ability to follow two consecutive commands successfully | ||
Revisión actual - 14:50 14 oct 2019
LP without CT is likely safe if:[1]
- History
- Age < 60
- Not immunocompromised
- No history of CNS disease
- No seizure within 1 week of presentation
- Physical Exam
- No altered level of consciousness
- Ability to answer two consecutive questions successfully
- Ability to follow two consecutive commands successfully
- Normal neurologic exam
- No altered level of consciousness
If none of the above, chance of normal ct is 97%; none of the patients herniated
CT findings that prohibit LP:[2]
- Midline shift
- Unequal pressures between the 3 cerebral compartments (left/right supretentorial compartments, posterior fossa)
- Intracerebral masses not causing midline shift
- Obstructive Hydrocephalus
- Enlargement of ventricles prox to lesions and normal ventricles distal (especially 4th ventricle)
- Basilar cisterns compressed
- Lateral/3rd ventricles may be small due to diffuse cerebral edema or enlarged due to obstr. hydroceph. +/- shift
- Posterior fossa mass
- Displacement/compression of 4th ventricle