Lumbar puncture

Perform a lumber puncture (LP) if there are no contraindications and the investigation does not delay critical treatment such as antibiotic therapy.

Indications: sepsis/bacterial meningitis; herpes simplex encephalitis, tuberculous meningitis and cause unknown. [1]

Analyse the CSF for:

• Microscopy
• Gram staining
• Culture and sensitivity
• Glucose, protein and PCR for herpes simplex and other viruses [1]

Contraindications are:

• GCS 8 or less or deteriorating
• Focal neurological signs or abnormal posture
• Prolonged seizure lasting 10 minutes or more and a GCS of 12 or less
• Shock
• Systemic meningococcal disease
• Signs of raised intracranial pressure: unilateral or bilateral dilated pupils or sluggish pupillary reaction
• Bradycardia or hypertension
• Abnormal breathing pattern