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Computed Tomography for Predicting Complications of Lumbar Puncture

Osama O. Zaidat, MD; Jose I. Suarez, MD
JAMA. 2000;283(8):1004. doi:10.1001/jama.283.8.999.
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To the Editor: Dr Attia and colleagues1 concluded that in the presence of the sensitive clinical signs in adults with possible meningitis, the physician should proceed directly with lumbar puncture (LP) in high-risk patients. Although we agree with this statement we would like to emphasize that lethal complications, such as cerebral herniation, may be caused by LP.2 An axial computed tomographic (CT) scan of the head must be obtained to identify those patients at risk. The American Academy of Neurology2 indicated that CT is better than clinical examination in predicting the risk of herniation and death in those patients with increased intracranial pressure due to a mass lesion or obstruction of the ventricular system. It has been shown that clinical examination and presence of papilledema are not adequate to exclude the possibility of cerebral herniation.3 Structural characteristics defined by CT provide valuable information about the pressure gradient between different compartments of the brain.

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