Gopal et al1 found that altered mentation, focal neurological examination, papilledema, and the overall clinical impression of the examiner predicted the presence of intracranial lesions and of findings that contraindicted lumbar puncture (LP) on cranial computed tomography (CT) in patients presenting to the emergency department. The goal of their study was to identify patients who can safely undergo LP without screening CT. We have several questions and comments regarding their methods and conclusions and would like to present some data of our own.
Linden CH, James WA, Hartigan CF. Cranial Computed Tomography Before Lumbar Puncture. Arch Intern Med. 2000;160(18):2868-2870. doi: