Quote:
>JE> A friend was recently admitted to North Carolina Memorial Hospital
>JE> because of suspected meningitis. Serious business. They wanted to do
>JE> a lumbar puncture, for which a CT scan is a prerequisite.
>The last statement is actually not true. There is a myth that
>lumbar puncture can cause brain herniation in a patient with
>increased intracranial pressure and/or an intracranial mass. There
>is zero credible evidence that LP causes herniation in these or any
>other circumstances. However, this is irrelevant to your question.
Excuse me? There is *no* credible evidence that LP causes herniation in a
patient with raised ICP? Are you serious?
There is plenty. The phenomenon is known as 'coning', and if you bother to
search the Registrar's database in most places, you will find that there
are deaths caused by compression of the medulla through the foramen magnum,
coincident with an LP. You may be right about not needing a CT before LP, and
with a lot of care (as in manometry before taking samples) you can avoid this
disaster, but it happens. It used to happen a lot more often, before docs got
clued in, and it still does occasionally, with a fool taking the LP...
To put all that in perspective, the risk is small, vanishingly so in the
absence of severely raised intracranial pressure. But in cases of severely
raised ICP (not including benign IC hypertension - there's a different
mechanism involved there), there is a real risk of coning and consequent
death.