Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
Copyright 2000 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2000
In Reply: We appreciate Drs Zaidat and Suarez's
caveats regarding CT scanning before LP. The intent of our article was to
review the accuracy of the clinical examination in the diagnosis of meningitis
before other diagnostic tests are undertaken. Once a clinician suspects bacterial
meningitis, further testing is warranted provided it does not unduly delay
the initiation of appropriate antibiotic treatment.
The risk of LP in adult patients suspected of having meningitis has
been debated for years.1 A systematic review
of the retrospective literature on LP in acute meningitis suggests patients
at high risk of cerebral herniation may have any of the following clinical
features: decreased level of consciousness, focal neurological signs, papilledema,
or atypical features (immunocompromised, sinusitis, otitis).1
In centers with rapid access to CT scanning, the approach suggested by Zaidat
and Suarez is appropriate. In centers without access to CT scan technology,
LP remains the diagnostic test of choice. Nevertheless, additional prospective
studies are necessary to define the incidence of complications following LP
in adult patients suspected of having bacterial meningitis and clinical features
that may predict which patients are at risk for these complications.
Hatala R, Attia J. Computed Tomography for Predicting Complications of Lumbar Puncture—Reply. JAMA. 2000;283(8):1004. doi:10.1001/jama.283.8.999