Lumbar puncture

hrhodes's version from 2015-10-17 23:31


Question Answer
Indications for LP after a febrile seizure Signs of meningism, age6-12months and S.pneumoniae vaccination unclear/not done, Complex febrile (>30mins) or on antibiotics that could mask meningitis
What are the features of bacterial meningitis on CSF analysis?High opening pressure >30cmH20, turbid colour, raised protein >1g/L, Low glucose <2.2, WCC >500 with polymorphs, CSF:serum glucose <0.4
What are the features of viral meningitis on CSH analysis?Normal opening pressure 5-20cmH2O, Clear, Normal/slightly elevated protein <1, normal glucose 2.5-3.5, normal CSF:serum glucose 0.6, WCC<1000 mainly monocytes
What are the features of TB meningitis on CSF?normal to slightly high opening pressure <30cmH2O, fibrin web appearance, Slightly high protein >1g/L, slightly low glucose <2.4, CSF:serum glucose <0.4, Cell count 100-500, monocytes
If suspecting fungal infection like cryptococcal what do you do?India Ink stain
If suspecting viral meningitis or encephalitis what do you also send?HSV1 PCR (100% sense), CMV PCR, entero- and adeno- PCR, VZV PCR


Question Answer
LP in UTI in 1-3month oldsif UTI confirmed then traditionally was thought to be due to seeding rather than ascending infection. In well looking infants don't LP but admit and consider LP if unwell/toxic


                                              Normal Bacterial Viral TB/fungal
Pressure 5-20 >30 Normal slightly high
Appearance Clear Turbid Clear Fibrin web
Protein g/L <0.5 >1 <1 <0.5
Glucose mmol/L 2.5-3.5 <2.2 Normal <1.6-2.4
Gram stain Normal 60-90% Normal Low sensitivity AFB
WCC <3 >500 <1000 100-500
Glucose CSF: seru0.6 <0.4 >0.6 <0.4
Cell type Polymorphs Monocytes Monocytes