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February 23, 2000

Computed Tomography for Predicting Complications of Lumbar Puncture—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(8):1004. doi:10.1001/jama.283.8.999

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.

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