The efficacy of routine head computed tomography (CT scan) prior to lumbar puncture in the emergency department

Baker, Nancy; Kharazi, H. Haizadch; Laurent, Lisa; Walker, Andrew; Williamson, Daniel; Weissman, Barbara N.; Zamani, Amir A.; Sánchez, Ricardo Mondragón

doi:10.1016/0736-4679(94)90409-x

Cited by 25 publications

(29 citation statements)

References 8 publications

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“…Lumbar puncture was first described as a diagnostic test by Quincke in 1891 1 . Lumbar punctures are typically performed for diagnostic purposes to collect cerebrospinal fluid (CSF) for laboratory analysis.…”

Section: Introductionmentioning

confidence: 99%

Multidetector CT-Guided Lumbar Puncture in Patients with Cancer

et al. 2009

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Lumbar puncture can be performed for therapeutic purposes, to instill intrathecal chemotherapy for leptomeningeal cancer treatment or prophylaxis. This technique is generally performed blindly or under fluoroscopic guidance. However, in certain situations, lumbar puncture using multidetector CT (MDCT)-guided imaging may be beneficial, when other options have been exhausted or depending on the requirements of the performing radiologist's institution. The purpose of this article is to describe the technique and to evaluate outcomes of MDCT-guided lumber puncture for diagnostic and therapeutic purposes in patients with cancer. We conclude that MDCT-guided lumbar puncture is an effective and safe guiding modality for thecal sac access in patients with cancer, particularly where other methods of intrathecal access have failed.

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Section: Introductionmentioning

confidence: 99%

Multidetector CT-Guided Lumbar Puncture in Patients with Cancer

et al. 2009

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“…Kastenbauer reported that 8 out of 10 cases (80%) of brain herniation in adults with meningitis had normal CT prior to LP (Kastenbauer, Winkler, & Pfister, 2002). Baker reported 6 out of 13 cases (46%) of high ICP measured by LP had normal CT (Baker et al, 1994). A normal CT scan does not mean LP is totally safe.…”

Section: Discussionmentioning

confidence: 99%

Acute Bacterial Meningitis Complicated by Brain Herniation Shortly after Lumbar Puncture: A Case Report

Noaim

2018

GJHS

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“…The introduction of computed cranial tomography (CT) in the 1970's and 1980's obviated the need for LP in most patients with space-occupying lesions (SOLs) and helped to define contraindications to LP in many other conditions [29]. However, in recent years there has been renewed discussion about whether we should perform CT before LP in some cases [28] or even, in emergency departments, routinely [6,12]. This controversy has included discussion of acute meningitis [4,50,62,67], where LP has traditionally been regarded as mandatory and urgent.…”

Section: Introductionmentioning

confidence: 99%

“…However, the declining use of LP has not diminished the fear of herniation: CT before LP is requested more and more [6,12]. As yet, there is no consensus on the indications of CT before LP, or on the effectiveness of CT to detect patients in which it may occur, especially in (children with) meningitis [4,60].…”

Section: Introductionmentioning

confidence: 99%

Lumbar puncture and the risk of herniation: when should we first perform CT?

Crevel¹,

Hijdra²,

Gans³

2002

J Neurol

123

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Death following lumbar puncture (LP) is feared by physicians. Many opinions are found in literature on the question whether computed cranial tomography (CT) should be performed before LP, to prevent herniation. These opinions are mainly based on retrospective studies and pathophysiological reasoning. In this review the difficulties in the decision whether we should perform CT before LP are discussed. It is explained that the concept of "raised intracranial pressure" is confusing, and that the less ambiguous terms "brain shift" and "raised CSF pressure" should be used instead. Brain shift is a contraindication to LP, whether CSF pressure is raised or not, and whether papilloedema is present or not. Subsequently, recommendations are offered for indications to perform CT before LP, grouped according to the safety and clinical utility of LP.

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The efficacy of routine head computed tomography (CT scan) prior to lumbar puncture in the emergency department

Cited by 25 publications

References 8 publications

Multidetector CT-Guided Lumbar Puncture in Patients with Cancer

Multidetector CT-Guided Lumbar Puncture in Patients with Cancer

Acute Bacterial Meningitis Complicated by Brain Herniation Shortly after Lumbar Puncture: A Case Report

Lumbar puncture and the risk of herniation: when should we first perform CT?

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