Authors' objectives:

This aim of this report was to assess whether, in children with suspected meningitis, brain CT scan is required before lumbar puncture in order to prevent the risk of cerebral herniation following lumbar puncture due to raised intracranial pressure.

Authors' recommendations: 1. Does lumbar puncture increase the risk of cerebral herniation? Answer: The literature does not provide strong evidence to answer this question. Points to Note: - Cerebral herniation does occur without lumbar puncture in this patient group. - Cerebral herniation can occur after lumbar puncture, but it is not clear whether this is caused by the lumbar puncture, is made more likely by the lumbar puncture, or is as a result of the natural progression of the disease. 2. Does raised intracranial pressure (ICP) increase the risk of cerebral herniation following lumbar puncture? Answer: There is an assumption in the literature that this is the case, but there is no clear evidence to support this assumption. 3. Does computed tomography (CT) diagnose raised ICP more accurately than clinical examination? Answer: This question cannot be answered from the literature as in this population raised ICP is a contraindication to lumbar puncture and LP is the gold standard reference test for measurement of ICP. To answer this question we would need a study in which all the subjects received all three tests (clinical examination, CT scan and the reference standard lumbar puncture). It is unlikely that such a study would be done as there is an ethical difficulty in performing lumbar puncture on patients suspected to have raised ICP. Points to Note: - A normal CT scan does not rule out raised ICP 4. Does CT predict the likelihood of cerebral herniation following lumbar puncture more accurately than clinical examination? Answer: As for Question 3, this question cannot be answered from the literature as in this population abnormal clinical examination and/or abnormal CT scan are a contraindication to lumbar puncture (LP). Points to Note: - A normal CT scan does not rule out herniation following lumbar puncture.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.med.monash.edu.au/healthservices/cce/evidence/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Centre for Clinical Effectiveness

Contact Address: Monash Institute of Health Services Research, Block E, Monash Medical Centre, Locked Bag 29, Clayton, Victoria 3168, Australia. Tel: +61 3 9594 7505; Fax: +61 3 9594 7552.

Contact Name: cce@med.monash.edu.au.

Contact Email: cce@med.monash.edu.au.

Copyright: Centre for Clinical Effectiveness (CCE)