Cranial Computed Tomography Before Lumbar Puncture

Gopal, Ajai; Whitehouse, J D; Simel, David L.; Corey, G. Ralph

doi:10.1001/archinte.159.22.2681

Cited by 91 publications

(39 citation statements)

References 34 publications

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“…Interposition of CT scanning before lumbar puncture delayed initiation of antibiotic therapy by an average of 2 hours. Similar data on delay of initiation of treatment were reported by Gopal et al 17 and Linden et al 22 In the hospital setting of the study reported by Talan et al, CT scanning was available 24 hours a day. Even in settings where CT examination can be completed in 15 to 20 minutes, there is always the possibility of unexpected delay.…”

Section: Ct Examination Risks a Delay In Start Of Antimicrobial Managsupporting

confidence: 73%

Fatal Lumbar Puncture: Fact Versus Fiction—An Approach to a Clinical Dilemma

Oliver¹,

Shope²,

Kuhns

2003

Pediatrics

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ABSTRACT. Recent reports and commentaries have emphasized the alleged risk of cerebral herniation complicating lumbar puncture performed to diagnose acute bacterial meningitis. Instead, knowledge of facts relevant to the disease process can provide a rational and reassuring approach to management. All cases of purulent meningitis are associated with increased intracranial pressure, but herniation is a rare complication (5%). Despite suggestions to the contrary, cranial computed tomography (CT) is normal in most cases of purulent meningitis, including those with subsequent herniation. Additionally, CT may be associated with long-term radiation effects. An accurate clinical history combined with recognition of the early systemic and neurologic findings of bacterial meningitis will indicate a safe setting for performance of a diagnostic lumbar puncture with little likelihood of complicating herniation. In contrast, in patients in whom the disease process has progressed to the neurologic findings associated with impending cerebral herniation, a delay of the diagnostic procedure is indicated. In this latter circumstance, a different approach in management can be developed. Pediatrics 2003;112:e174-e176. URL: http://www.pediatrics.org/cgi/content/full/112/3/e174; lumbar puncture, computed tomography.

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Section: Ct Examination Risks a Delay In Start Of Antimicrobial Managsupporting

confidence: 73%

Fatal Lumbar Puncture: Fact Versus Fiction—An Approach to a Clinical Dilemma

Oliver¹,

Shope²,

Kuhns

2003

Pediatrics

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“…Altered mentation (likelihood ratio [LR], 2.2; 95% confidence interval [CI], 1.5-3.2), focal neurological finding (LR, 4.3; 95% CI, 1.9-10), and papilledema (LR, 11; 95% CI, 1.1-115) increased the likelihood of an intracranial lesion. 12 Overall clinical impression (not defined in the study) was able to identify patients with a CT-defined contraindication to LP (LR, 19; 95% CI, 4.8-43). In a second prospective study of 301 patients with suspected meningitis, 235 underwent a CT scan prior to LP.…”

Section: What Are the Contraindications To Performing An Lp?mentioning

confidence: 87%

“…In a prospective study, 113 patients were examined by internal medicine residents (overseen by emergency physicians) prior to undergoing computed tomography (CT) of the brain and subsequent LP. 12 The median age of patients was 42 years, 36% were immunocompromised, and 46% of patients had altered mentation. Altered mentation (likelihood ratio [LR], 2.2; 95% confidence interval [CI], 1.5-3.2), focal neurological finding (LR, 4.3; 95% CI, 1.9-10), and papilledema (LR, 11; 95% CI, 1.1-115) increased the likelihood of an intracranial lesion.…”

Section: What Are the Contraindications To Performing An Lp?mentioning

confidence: 99%

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How Do I Perform a Lumbar Puncture and Analyze the Results to Diagnose Bacterial Meningitis?

Straus¹,

Thorpe²,

Holroyd‐Leduc³

2006

JAMA

145

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“…In such cases, the damaged tissue will not be repaired [3]. When it comes to negative effects on human body, natural radiation is considered as a very important phenomenon.…”

Section: Introductionmentioning

confidence: 99%

An Investigation of Radiation Protection Status in Radiology Centers of Kurdistan in 2014-2015

Ebrahimzadeh¹,

Eslami²,

Bidarpoor³

et al. 2017

Health

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Using personal protective equipment (PPE) properly and following available rules and regulations in the field of ionizing radiation protection can significantly decrease these harms. If these equipment and facilities are not available in diagnostic radiation centers or are not used properly, radiographers' and people's health will be jeopardized. To date, no study has examined the protective condition against radiation in diagnostic radiation centers of Kurdistan province. The present study, therefore, was an attempt to address this gap. This cross-sectional study was conducted in 2014-2015 among 35 diagnostic radiation centers of Kurdistan. Data were collected through a checklist (which was developed based on the available radiation protection laws), a survey for patients and their caregivers, and in-site observation and dosimetry. The radiation health expert of the province proceeded to each of the radiology centers personally. Upon arrival to each center, he informed health physics officials of the centers about the study and collected data through observation, interview, and the checklist. On the other hand, in order to examine radiation leakage in different modes of imaging session, dosimetry was conducted by the use of an environmental dosimeter (Fluke 451 manufactured in the United States). The collected data were analyzed through Excel. It was found that in 67.3% of the cases, there was personal protective equipment for patients and their caregivers (robes, thyroid strap, gonadal shield, glasses, and lead gloves). Furthermore, this equipment and other physical holders were used for patients and their caregivers in 75.7% of the cases. This rate was 87.6% for pregnant women. In addition, we found that around 94% of the personnel went through medical examinations every six or twelve months, a rate that was much higher than that found in Nohi's study. When it comes to improving the indices of protection against radiation in radiation centers, it seems that adding the proposed items in this study to the present data collection form (form 110 used for urban areas) or designing a new form will change the attitude toward 850the concept of protection. This will highlight the importance of this topic and will result in decision makers' more serious attempts to promote the protection condition.

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Cranial Computed Tomography Before Lumbar Puncture

Cited by 91 publications

References 34 publications

Fatal Lumbar Puncture: Fact Versus Fiction—An Approach to a Clinical Dilemma

Fatal Lumbar Puncture: Fact Versus Fiction—An Approach to a Clinical Dilemma

How Do I Perform a Lumbar Puncture and Analyze the Results to Diagnose Bacterial Meningitis?

An Investigation of Radiation Protection Status in Radiology Centers of Kurdistan in 2014-2015

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