Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Early lumbar puncture in adult bacterial meningitis-rationale for revised guidelines

Glimaker, Martin ; Johansson, Bibi ; Bell, Max ; Ericsson, Mats ; Bläckberg, Jonas LU ; Brink, Magnus ; Lindquist, Lars and Sjolin, Jan (2013) In Scandinavian Journal of Infectious Diseases 45(9). p.657-663
Abstract
Current international guidelines recommend cerebral computerized tomography (CT) before lumbar puncture (LP) in many adults with suspected acute bacterial meningitis (ABM), due to concern about LP-induced cerebral herniation. Despite guideline emphasis on early treatment based on symptoms, performing CT prior to LP implies a risk of delayed ABM treatment, which may be associated with a fatal outcome. Firm evidence for LP-induced herniation in adult ABM is absent and brain CT cannot discard herniation. Thus, the recommendation to perform CT before LP may contribute to an avoidable delay of LP and ABM treatment. The inappropriate use of the diagnostic treatment sequence of brain CT scan, followed by LP, followed by antibiotics and... (More)
Current international guidelines recommend cerebral computerized tomography (CT) before lumbar puncture (LP) in many adults with suspected acute bacterial meningitis (ABM), due to concern about LP-induced cerebral herniation. Despite guideline emphasis on early treatment based on symptoms, performing CT prior to LP implies a risk of delayed ABM treatment, which may be associated with a fatal outcome. Firm evidence for LP-induced herniation in adult ABM is absent and brain CT cannot discard herniation. Thus, the recommendation to perform CT before LP may contribute to an avoidable delay of LP and ABM treatment. The inappropriate use of the diagnostic treatment sequence of brain CT scan, followed by LP, followed by antibiotics and corticosteroids should be avoided in adults with suspected ABM by omitting needless contraindications for LP, thus eliminating an unnecessary fear of immediate LP. Revised Swedish guidelines regarding early LP are presented, and the background documentation and reasons for omitting impaired consciousness, new onset seizures, and immunocompromised state as contraindications to LP are discussed. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Meningitis, lumbar puncture, herniation, antibiotics, treatment delay
in
Scandinavian Journal of Infectious Diseases
volume
45
issue
9
pages
657 - 663
publisher
Informa Healthcare
external identifiers
  • wos:000323242800001
  • scopus:84882321661
  • pmid:23808722
ISSN
1651-1980
DOI
10.3109/00365548.2013.799289
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Division of Infection Medicine (SUS) (013008000)
id
649a4d9e-72a8-4151-b4b6-6c3e64df91dc (old id 4027186)
date added to LUP
2016-04-01 15:01:03
date last changed
2022-01-28 03:37:40
@article{649a4d9e-72a8-4151-b4b6-6c3e64df91dc,
  abstract     = {{Current international guidelines recommend cerebral computerized tomography (CT) before lumbar puncture (LP) in many adults with suspected acute bacterial meningitis (ABM), due to concern about LP-induced cerebral herniation. Despite guideline emphasis on early treatment based on symptoms, performing CT prior to LP implies a risk of delayed ABM treatment, which may be associated with a fatal outcome. Firm evidence for LP-induced herniation in adult ABM is absent and brain CT cannot discard herniation. Thus, the recommendation to perform CT before LP may contribute to an avoidable delay of LP and ABM treatment. The inappropriate use of the diagnostic treatment sequence of brain CT scan, followed by LP, followed by antibiotics and corticosteroids should be avoided in adults with suspected ABM by omitting needless contraindications for LP, thus eliminating an unnecessary fear of immediate LP. Revised Swedish guidelines regarding early LP are presented, and the background documentation and reasons for omitting impaired consciousness, new onset seizures, and immunocompromised state as contraindications to LP are discussed.}},
  author       = {{Glimaker, Martin and Johansson, Bibi and Bell, Max and Ericsson, Mats and Bläckberg, Jonas and Brink, Magnus and Lindquist, Lars and Sjolin, Jan}},
  issn         = {{1651-1980}},
  keywords     = {{Meningitis; lumbar puncture; herniation; antibiotics; treatment delay}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{657--663}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Infectious Diseases}},
  title        = {{Early lumbar puncture in adult bacterial meningitis-rationale for revised guidelines}},
  url          = {{http://dx.doi.org/10.3109/00365548.2013.799289}},
  doi          = {{10.3109/00365548.2013.799289}},
  volume       = {{45}},
  year         = {{2013}},
}