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Guidelines for managing acute bacterial meningitis

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7245.1290 (Published 13 May 2000) Cite this as: BMJ 2000;320:1290

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Re: A normal CT scan does not mean a safe lumbar puncture

Dear Madam/ Sir

in response to the letter of Dr Cooper, I would like to add to my
comment that I did in no way mean to say that a normal CT scan rules out
complications at lumbar puncture. It goes without saying that the clinical
neurological examination has to performed first and that there are indeed
contraindications to lumbar puncture. What I did mean to say is that focal
neurological signs or symptoms of raised intracranial pressure should
alert the neurologist to order a CT scan instead of going ahead with
lumbar puncture. Even then, as Dr Cooper points out, a normal scan cannot
guarantee a safe lumbar puncture - it can only be a complement to the
clinical examination.

Competing interests: No competing interests

15 May 2000
Oliver Czech
senior house officer
Berlin, Germany