The place of computed tomography and lumbar puncture in suspected bacterial meningitis.

Mellor, D H

doi:10.1136/adc.67.12.1417

Cited by 54 publications

(33 citation statements)

References 17 publications

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“…Lumbar puncture would also aid in ruling out neonatal herpesvirus infection or enteroviral or parechovirus meningitis or meningoencephalitis. Conditions that may lead to a delay or cancellation of lumbar puncture include severely ill infants with either cardiovascular or respiratory distress, tense or bulging anterior fontanelle (for which a CT scan or MRI may be indicated to rule out significantly raised intracranial pressure prior to LP), the presence of severe thrombocytopenia, or infection around the lumbosacral region (167)(168)(169)(170).…”

Section: Cerebrospinal Fluid Testingmentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

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Section: Cerebrospinal Fluid Testingmentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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“…Medical measures to reduce ICP were instituted before LP was performed in those patients with features of increased ICP. At the discretion of the attending physician, LP was deferred in some children with suspected PM because of contraindications to LP (Mellor 1992). Patients were initially reviewed at least twice daily until stable and at least daily after stabilization.…”

Section: Participantsmentioning

confidence: 99%

“…High-risk patients were given a prognostic score of ≥ 4.5 points, and low-risk patients a score of ≤ 4.0 points, on a weighted scoring scheme including unrousable coma (3 points), hypothermia (temperature <36.6˚C [2 points]), convulsions (major motor or generalised [2 points]), shock (systolic blood pressure <60 mm Hg [1 point]), age <12 months (1 point), and symptoms persisting >3 days ( 1 ⁄ 2 point) (Gary et al 1989). A period of 24 hours was chosen as the cut-off point between early and late deaths as most deaths related to herniation following LP occur within 24 hours of the procedure (Mellor 1992, Rennick et al 1993.…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…Both the indications for and contraindications to LP in children with suspected PM are controversial (Brown 1976, Anonymous 1977, Illingworth 1977, Finley 1980, Lorber and Sunderland 1980, Addy 1987, Donald and Kibel 1988, Neville 1988, Mellor 1992. In developing countries, there is a practical need to assess these issues (Akpede and Sykes 1992).…”

mentioning

confidence: 99%

“…Failure to perform necessary LPs could result in the over-or under diagnosis of PM among the large number of possible diagnoses in acutely ill febrile children (Stanfield 1969, Patel 1971, Gamsu 1978. The performance of LPs in circumstances considered hazardous or in which the procedure might not further contribute to management of the illness (Addy 1987, Mellor 1992) must be examined. While much work has been done in relation to the issues outlined above, data are limited on the prevalence and implications of cerebral herniation in infants and children with PM in developing countries.…”

mentioning

confidence: 99%

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Cerebral herniation in pyogenic meningitis: prevalence and related dilemmas in emergency room populations in developing countries

Akpedez

Ambe

2000

Develop Med Child Neuro

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This study aimed to determine the frequency and outcome of possible cerebral herniation in relation to lumbar puncture (LP) in postneonatal infants and children with pyogenic meningitis in the tropics. Children with meningitis aged between 6 weeks and 15 years (mean age 4.07 years; n=123) were recruited consecutively over 31/2 years at the University of Maiduguri Teaching Hospital, Nigeria. The frequency of possible herniation was determined by clinical evaluation in relation to the severity of illness (high versus low risk) on presentation and performance of LP. Previously described scoring schemes were used. Eighteen (15%) patients had evidence of herniation on presentation. The relative risk (RR) of herniation in high‐ versus low‐risk patients was 66.6 (9.3 to 477.1, 95% CI), p<0.0001 while the RR of death or neurological sequelae in high‐ versus low‐risk patients was 2.6 (1.8 to 3.7, 95% CI), p<0.0001. In 99 patients with known outcomes who had LP on presentation, 21 of 81 without herniation pre‐ or post‐LP, four of four with herniation pre‐and post‐LP, seven of eight with herniation post‐LP only, and five of six with herniation pre‐LP only died or recovered with sequelae (χ2= 25.24, df= 3, p<0.0001). It is concluded that outcome depends on the severity of illness and the presence and timing of herniation. A policy of selective rather routine LPs may improve the outcome in meningitis in developing countries.

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

Crevel¹,

Hijdra²,

Gans³

2002

J Neurol

120

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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 place of computed tomography and lumbar puncture in suspected bacterial meningitis.

Cited by 54 publications

References 17 publications

Early-Onset Neonatal Sepsis

Early-Onset Neonatal Sepsis

Cerebral herniation in pyogenic meningitis: prevalence and related dilemmas in emergency room populations in developing countries

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

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