POTD: CT prior to LP
Happy Sunday everyone, hope everyone has had a good weekend. Your second favorite teaching resident here with a new POTD. This one brought to you by a conversation I had with doctors Duo Xu and Amish Aghera, inspired by when I had to go to the sim center and forgot my ID behind the lumbar puncture model.
Often it is a mantra to obtain a head CT before LP to assess for a process that increases intracranial pressure that could potentially cause highly morbid and dreaded brain herniation. However, a delay in care for a patient with suspected meningitis can be devastating.
Below are some guidelines developed by the IDSA for these situations
IDSA Guidelines for patients for patients who require a CT before LP:
Patients who are immunocompromised (HIV infection, taking immunosuppressants, or after transplantation)
Patients with a history of central nervous system disease (mass lesion, stroke, or focal infection)
Patients with new onset of seizure within one week of presentation
Patients with papilledema on fundoscopy
Patients with an abnormal level of consciousness
Patients with a focal neurologic deficit
For those who prefer visual representation (see the link below for inquiries about recs beyond timing of LP):
Research shows that physicians are not particularly adherent to these guidelines, (a study from Houston in the link below showed 60% adherence), but remembering them can save a patient from unneeded radiation, will prevent a delay of treatment, and can help lead to a more efficient and appropriate disposition.
Enjoy the beginning of Thanksgiving week everyone
Mak Sarich MD
References:
https://knowledgeplus.nejm.org/blog/suspected-bacterial-meningitis/