An 82 year old woman presents with fever, seizures and a history of anorexia, diarrhoea and vomiting.
List three (3) clinical features which would indicate the need for a brain CT scan prior to lumbar puncture in this patient?
1. New onset seizures
2. Immunocompromised state
3. Moderate to severe impaired level of consciousness
4. Focal neurological signs (signs suspicious of a space occupying lesion)
The question is really asking, "what are the features of increased intracranial pressure in the presence of a space-occupying lesion?"
Clinical features of increased intracranial pressure, specifically referring to patients with meningitis, are discussed elsewehere. The References section below contains a single article on this topic, well worth reading. The most important feature of it - Tabel 2 - is reproduced below to simplify revision.
Immunocompromised host |
|
History of focal CNS disease |
|
New onset of seizures |
|
Ongoing or recent seizures |
(Seizures in general seem to cause an increase in intracranial pressure, in the absence of a space-occupying lesion, and with a deceptively normal head CT.) |
Papilloedema |
|
Decreased level of consciousness |
|
Focal neurological signs |
|
Tunkel, Allan R., et al. "Practice guidelines for the management of bacterial meningitis." Clinical infectious diseases 39.9 (2004): 1267-1284.