Give 4 reasons a CT head may be indicated before performing a lumbar puncture in a patient with suspected meningitis?

  • CT imaging is important when raised ICP suspected:
    • Lumbar puncture may precipitate cerebral herniation
  • Should be performed if in all patients presenting with:
    • Focal neurologic deficits (excluding cranial nerve palsies) 1
    • New-onset seizures 1
    • Severely altered mental status (Glasgow Coma Scale score <10) 1
    • Severely immunocompromised state 1
  • In patients lacking these characteristics, CT imaging is not recommended before lumbar puncture