Diagnostic lumbar puncture in suspected acute bacterial meningitis: avoiding catastrophe

2013 ◽  
Vol 55 (12) ◽  
pp. 1068-1068
Author(s):  
Venkateswaran Ramesh
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Acute Bacterial Meningitis ◽  
Diagnostic Lumbar Puncture

Risk of diagnostic lumbar puncture in acute bacterial meningitis

1986 ◽  
Vol 2 (3) ◽  
pp. 180-182 ◽  
Author(s):  
FRED j. HELDRICH ◽  
STUART H. WALKER ◽  
&NA; CROSBY
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Acute Bacterial Meningitis ◽  
Diagnostic Lumbar Puncture

Acute Bacterial Meningitis

2015 ◽  
Author(s):  
Karen L. Roos
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Antimicrobial Therapy ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Patient Positioning ◽  
Acute Bacterial Meningitis ◽  
Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.   This review contains 8 highly rendered figures, 6 tables, and 75 references.

Acute Bacterial Meningitis

2015 ◽  
Author(s):  
Karen L. Roos
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Antimicrobial Therapy ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Patient Positioning ◽  
Acute Bacterial Meningitis ◽  
Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.   This review contains 8 highly rendered figures, 6 tables, and 75 references.

scholarly journals Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children with Acute Bacterial Meningitis

2013 ◽  
Vol 2 (2) ◽  
pp. 135-139 ◽  
Author(s):  
S Adhikari ◽  
E Gauchan ◽  
G BK ◽  
KS Rao
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Lumbar Puncture ◽  
Laboratory Finding ◽  
Clinical Findings ◽  
Acute Bacterial Meningitis ◽  
Antibiotic Administration ◽  
Intravenous Antibiotic ◽  
Considerable Difficulty

Background: Analysis of cerebrospinal fluid is gold standard for diagnosis of meningitis. There is considerable difficulty in interpreting laboratory finding after prior antibiotic therapy. This study was conducted to evaluate the effect of intravenous antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis. Methods: A hospital based retrospective study carried out using the data retrieved from the medical record department of Manipal Teaching Hospital Pokhara, Nepal; from 1st July 2006 to 31st July 2011. Clinical findings and relevant investigations were entered in a predesigned proforma. Patients were divided in two different groups as bacterial meningitis with and without prior intravenous antibiotic therapy. Various laboratory parameters including CSF were compared between these two groups using the statistical software, SPSS version 18.0. Results: A total of 114 children were included in this study among which 49(43%) children had received intravenous antibiotics before lumbar puncture. Mean CSF WBC count was(267.6± 211 vs. 208.1±125.3.3) and protein level (114.1±65.9 vs. 98.3±37.7mg/dl) in untreated vs. pretreated groups respectively. Neutrophil percentage was decreased (57.1±28.1vs.72.9±18.9) with higher CSF sugar level (43.3±11.8 vs. 51.2±13.2) after prior antibiotics therapy (p<0.001). Conclusion: Antibiotic pretreatment was associated with higher cerebrospinal fluid glucose levels with decreased neutrophils and increased lymphocytes. Pretreatment did not modify total cerebrospinal fluid white blood cell count and cerebrospinal fluid protein levels. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 135-139 DOI: http://dx.doi.org/10.3126/njms.v2i2.8963

scholarly journals Acute subdural hematoma as a complication of diagnostic lumbar puncture: case report

2016 ◽  
Vol 30 (4) ◽  
pp. 526-529
Author(s):  
Luis Rafael Moscote-Salazar ◽  
Andres M. Rubiano ◽  
Hernando Raphael Alvis-Miranda ◽  
Nasly Zabaleta-Churio ◽  
Willem Guillermo Calderón-Miranda ◽  
...  
Keyword(s):  
Case Report ◽  
Lumbar Puncture ◽  
Subdural Hematoma ◽  
Fluid Collection ◽  
Acute Subdural Hematoma ◽  
Acute Bacterial Meningitis ◽  
Red Flags ◽  
Diagnostic Lumbar Puncture ◽  
Head Computed Tomography

Abstract Background: Intracranial hemorrhagic complications are unusual after diagnostic lumbar puncture. Case report: A diagnostic lumbar puncture was performed in a 55 year-old male for acute bacterial meningitis workup. Immediately after the procedure he developed intense headache and a head Computed Tomography (CT) was done which identified an acute subdural fluid collection. No surgical management was offered and conservative medical follow-up was indicated. Conclusion: The occurrence of a headache with red flags after a lumbar puncture may suggest the possibility of an acute subdural hematoma.

Acute Bacterial Meningitis

2014 ◽  
Author(s):  
Karen L. Roos
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Antimicrobial Therapy ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Patient Positioning ◽  
Acute Bacterial Meningitis ◽  
Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.   This review contains 8 highly rendered figures, 6 tables, and 75 references.

Acute Illnesses in the 2 Weeks After Hospitalization for Bacterial Meningitis

PEDIATRICS ◽  
1987 ◽  
Vol 80 (3) ◽  
pp. 342-343
Author(s):  
Keith R. Powell ◽  
J. Owen Hendley ◽  
Anne Gadomski ◽  
Tarina Mendes ◽  
Jacob A. Lohr
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Acute Illness ◽  
Medical Attention ◽  
Hospital Records ◽  
End Of Treatment ◽  
Baseline Information ◽  
Diagnostic Lumbar Puncture

The hospital records of 118 2-month-old to 3-year-old children who had been treated for bacterial meningitis were reviewed. Within 2 weeks after hospitalization, one fourth of the patients sought medical attention for an acute illness, but only one was treated for the possible relapse or recurrence of meningitis. Because only five of the 113 patients with available follow-up information required a diagnostic lumbar puncture procedure, it is not recommended that a lumbar puncture be performed following treatment of bacterial meningitis to provide end-of-treatment baseline information.

scholarly journals Acute Bacterial Meningitis Complicated by Brain Herniation Shortly after Lumbar Puncture: A Case Report

2018 ◽  
Vol 10 (3) ◽  
pp. 121
Author(s):  
Khalid Ibrahim Al Noaim
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Skull Fracture ◽  
Acute Bacterial Meningitis ◽  
Normal Brain ◽  
Antibiotic Administration ◽  
Brain Herniation ◽  
Brain Ct ◽  
Neuroprotective Strategy ◽  
History Of

INTRODUCTION: Brain herniation is a known complication of acute bacterial meningitis. Brain CT is requested before the lumbar puncture to rule out increased intracranial pressure. Delay antibiotic administration, secondary to brain CT leads to a poor clinical outcome.CASE PROFILE: 10 year old boy had previous history of skull fracture and pneumococcal meningitis, presented to ER with history of fever, headache and vomiting for 2 days. Clinically, he was fully conscious and vitally stables with positive meningeal signs and normal other examinations. Brain CT was normal before the lumbar puncture. The lumbar puncture came suggestive of meningitis in the form of leukocytosis with low glucose and high protein. Antibiotics were given after the lumbar puncture. Two hours after the lumbar puncture, the patient had deteriorations in the level of consciousness and respiratory arrest followed by a coma. Brain CT was repeated which showed cerebellar herniation and subarachnoid hemorrhage. Neuroprotective strategy was performed without improvements. Blood and CSF cultures showed pneumococcal growth. After onne week, brain death was confirmed.CONCLUSION: Brain herniation is a severe complication of bacterial meningitis. Clinical findings are the best indicators to delay the LP and to predict the risk of herniation. Normal brain CT doesn’t necessarily mean LP is safe. Early antibiotics administrations improve the mortality and morbidity. Unnecessary CT before the LP lead to a delay of antibiotic administration and poor outcome.

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