emDocs - April 24, 2017 - Authors: April M and Long B - Edited by: Koyfman A
"Key Takeaways:
- The best available evidence suggests some association between LP and brainstem herniation in patients with intracranial mass effect lesions.
- However, this risk is small, and there is no evidence that deferring LP prevents herniation in patients with these lesions.
- Decision rules that attempt to identify patients most likely to have intracranial lesions with risk for post-LP herniation have several limitations and have not been validated.
- Patients with significant pre-test probability for intracranial mass effect lesion or bacterial meningitis based on clinical assessment should receive head CT.
- Antimicrobials are required if meningitis is suspected.
- Concern for meningitis warrants antibiotics before CT if imaging will be obtained."