A previously well, 19-year-old female presents with fever, headache, photophobia and neck stiffness.
a) List three clinical features that would indicate the need for a brain CT scan prior to lumbar puncture in this patient. (25% marks)
- Immunocompromised state
- Altered level of consciousness
- Focal neurology (? Space occupying lesion)
- History of CNS disease (mass lesion, stoke, local infection)
- New onset seizures
Features which would make one want to exclude space-occupying lesions before performing an LP:
- Hypertension and bradycardia
- Focal neurological signs
- Decreased level of consciousness
- A new onset of seizures - however, this does not necessarily scream "abscess" because about 25% of meningits patients will have a seziure during their meningitis episode.
- Predisposition to infection (eg. immunocompromised state)
- History of stroke or intracranial space-occupying lesion
Oh's Manual only lists papilloedema seizures and focal neurological signs as contraindications to an LP.
Oh's Intensive Care manual: Chapter 54 (pp. 597) Meningitis and encephalomyelitis by Angus M Kennedy
Beaman, Miles H. "Community‐acquired acute meningitis and encephalitis: a narrative review." Medical Journal Of Australia209.10 (2018): 449-454.
Lee, Bonita E., and H. Dele Davies. "Aseptic meningitis." Current opinion in infectious diseases 20.3 (2007): 272-277.
Beer, R., P. Lackner, and B. Pfausler. "Nosocomial ventriculitis and meningitis in neurocritical care patients." Journal of neurology 255.11 (2008): 1617-1624.
Korinek, A-M., et al. "Prevention of external ventricular drain–related ventriculitis." Acta neurochirurgica 147.1 (2005): 39-46.
NSW Health. Infants and children: acute management of bacterial meningitis: clinical practice guideline. North Sydney: NSW Ministry of Health; 2014.
Tunkel, Allan R., et al. "Practice guidelines for the management of bacterial meningitis." Clinical infectious diseases 39.9 (2004): 1267-1284.
Hearmon, Christine J., and Salil K. Ghosh. "Listeria monocytogenes meningitis in previously healthy adults." Postgraduate medical journal 65.760 (1989): 74-78.
Chong, H. T., and C. T. Tan. "Epidemiology of central nervous system infections in Asia, recent trends." Neurology Asia 10 (2005): 7-11.