When should brain imaging precede lumbar puncture in cases of suspected bacterial meningitis?

Aibek E. Mirrakhimov; Adam Gray; Taha Ayach

doi:10.3949/ccjm.84a.16028

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When should brain imaging precede lumbar puncture in cases of suspected bacterial meningitis?

Aibek E. Mirrakhimov, MD, Adam Gray, MD and Taha Ayach, MD

Cleveland Clinic Journal of Medicine February 2017, 84 (2) 111-113; DOI: https://doi.org/10.3949/ccjm.84a.16028

Aibek E. Mirrakhimov

Assistant Professor, Department of Medicine, University of Kentucky College of Medicine, Lexington

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For correspondence: [email protected]

Adam Gray

Assistant Professor, Department of Medicine, University of Kentucky College of Medicine, Lexington

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Taha Ayach

Assistant Professor, Department of Medicine, University of Kentucky College of Medicine, Lexington

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TABLE 1
Common indications for brain imaging before lumbar puncture
Altered mental status
Focal neurologic deficits
Seizures within 1 week
Papilledema
Immunodeficiency
History of central nervous system disease
Age ≥ 60
High clinical suspicion for subarachnoid hemorrhage

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TABLE 2

General contraindications to lumbar puncture

Skin infection at the puncture site

Spine infection at the puncture site

Thrombocytopenia (platelet count < 50 × 10⁹/L) or use of antithrombotic agents other than aspirin

Coagulopathy (international normalized ratio > 1.4) or use of anticoagulants

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Cleveland Clinic Journal of Medicine

Vol. 84, Issue 2

1 Feb 2017

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