The Rational Clinical Examination
David L. Simel, Drummond Rennie
Lumbar Puncture
David L. Simel
Make the Diagnosis: Lumbar Puncture to Diagnose Bacterial Meningitis
Topics Discussed:
back pain, cerebrospinal fluid analysis, confidence interval, criterion standard comparisons (diagnostic tests), diagnosis, diagnostic process, diagnostic spinal puncture, headache, likelihood ratio, make the diagnosis, meningitis, bacterial, positioning patient, postdural puncture headache
Excerpt:
"A lumbar puncture (LP) to obtain cerebrospinal fluid (CSF) is
necessary for diagnosing bacterial meningitis because neither individual
symptoms or signs or combinations of findings have sufficient diagnostic
accuracy. In addition, microbiological culture of CSF is necessary
to guide antibiotic therapy. The basic approach to LP is the same
whether or not bacterial meningitis is the most likely diagnosis.No studies evaluate the success of the most commonly used patient
position, lateral recumbent with knees to chest, compared to alternatives
of having the patient sit and bend forward over an adjustable bedside
stand or having the patient sit with feet supported and chest resting
on the knees. However, the interspinous distance is greatest when
the patient is sitting with the feet supported. Unfortunately, the
CSF pressure cannot be measured in that position...."
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