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Computed tomography of the head before a lumbar puncture in suspected meningitis -- is it helpful?

Meningitis remains a formidable foe because it often progresses rapidly and causes substantial morbidity and mortality.1–3 The rational management of meningitis has generally included a lumbar puncture to substantiate the diagnosis and help identify the cause. In rare cases, however, this maneuver is followed by cerebral herniation, which is sometimes fatal.4–6 Lumbar puncture generally results in a small, transient decrease in cerebrospinal fluid pressure throughout the subarachnoid space as a result of both the removal of fluid and the continued leakage of cerebrospinal fluid from the opening made in the arachnoid membrane.4 In the presence of a space-occupying . . .