Computed Tomography of the Head before Lumbar Puncture in Adults with Suspected Meningitis

Hasbun, Rodrigo; Abrahams, James J.; Jekel, James F.; Quagliarello, Vincent

doi:10.1056/nejmoa010399

Cited by 408 publications

(168 citation statements)

References 17 publications

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“…When this is suspected, rapid bedside evaluation and head CT are indicated. Several studies in patients with meningitis have suggested that CT should precede lumbar puncture in patients with signs such as optic disc edema, new seizures, or severe impairment of consciousness (see Table 10 in [65] for a succinct summary of contraindications to lumbar puncture) [134][135][136]. In practice, we find that most patients have had an initial CT scan in the emergency department prior to neurological evaluation.…”

Section: Edema and Herniationmentioning

confidence: 86%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

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Section: Edema and Herniationmentioning

confidence: 86%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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“…Third, the majority underwent cranial imaging (90%) and had normal results, despite the fact that only a minority of patients met imaging criteria. 1,17 Fourth, despite extensive diagnostic testing with current techniques, most of the patients (72%) had an unknown etiology.…”

Section: Discussionmentioning

confidence: 99%

Meningitis With a Negative Cerebrospinal Fluid Gram Stain in Adults: Risk Classification for an Adverse Clinical Outcome

Khoury

Hossain

Wootton

et al. 2012

Mayo Clinic Proceedings

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Objective: To derive and validate a risk score for an adverse clinical outcome in adults with meningitis and a negative cerebrospinal fluid (CSF) Gram stain. Patients and Methods: We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1, 2005, and January 1, 2010. The patients were divided into derivation (Nϭ292) and validation (Nϭ275) cohorts. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results: Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model was created using 3 baseline variables that were independently associated with an adverse clinical outcome (PϽ.05): age greater than 60 years, abnormal findings on neurologic examination (altered mental status, focal neurologic deficits, or seizures), and CSF glucose level of less than 2.4975 mmol/L (to convert CSF glucose to mmol/L, multiply by 0.05551). The model classified patients into 2 categories of risk for an adverse clinical outcome-derivation sample: low risk, 0.6% and high risk, 32.8%; PϽ.001; and validation sample: low risk, 0.5% and high risk, 21.1%; PϽ.001. Conclusion: Adults with meningitis and a negative CSF Gram stain can be accurately stratified for the risk of an adverse clinical outcome using clinical variables available at presentation.

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“…1,5 Seizures, focal neurologic deficits, papilledema, and altered consciousness may predict increased ICP in the setting of normal-appearing radiologic images in acute meningitis. 1,6 While some experts propose that these clinical signs warrant performance of CT prior to LP, 7 others suggest that their presence should lead to deferment of LP. 1 The potential diagnostic uncertainty if LP is deferred may be mitigated by laboratory testing such as blood cultures (positive in 40%-50% of patients with meningococcal meningitis and 80%-90% with pneumococcal or Hemophilus meningitis).…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: A 44-year-old woman with headache followed by sudden neurologic decline

Berkowitz

Kimchi²,

Hwang³

et al. 2013

Neurology

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Computed Tomography of the Head before Lumbar Puncture in Adults with Suspected Meningitis

Abstract: In adults with suspected meningitis, clinical features can be used to identify those who are unlikely to have abnormal findings on CT of the head.

Cited by 408 publications

References 17 publications

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Meningitis With a Negative Cerebrospinal Fluid Gram Stain in Adults: Risk Classification for an Adverse Clinical Outcome

Clinical Reasoning: A 44-year-old woman with headache followed by sudden neurologic decline

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