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Please use this identifier to cite or link to this item: http://hdl.handle.net/1807/22480


Title: LUMBAR PUNCTURE IN BRAIN ABSCESS OR SUBDURAL EMPYEMA: NOT AN INNOCUOUS PROCEDURE
Authors: Nadvi, Syed S.
Nathoo, Narendra
van Dellen, James R.
Keywords: cerebrospinal fluid, intracranial brain abscess, lumbar puncture, subdural empyema
abcès intracrânien, empyéme sous-dural intra-crânien, liquide cérébro-spinal, ponction lombaire
Issue Date: 31-Dec-2001
Publisher: Pan African Association of Neurological Sciences
Citation: African Journal of Neurological Sciences (ISSN: 1015-8618) Vol 20 Num 1
Abstract: Background: Many authors have strongly cautioned against the performance of lumbar puncture in patients with suspected or likely infective intracranial mass lesions due to the dubious value of the CSF analysis so obtained, and due to the inherent danger of clinical deterioration precipitated by a pressure cone. Objective: To assess the role of lumbar puncture (LP) in aiding diagnosis and influencing outcome in patients with intracranial brain abscess or subdural empyema. Methods: The records of patients admitted with space occupying intracranial infective mass lesions (brain abscess and subdural empyema) to the neurosurgical unit at Wentworth Hospital, Durban, over a 15 year period, were retrospectively reviewed. Of the 1411 patients admitted with intracranial suppurative disorders (brain abscess = 712) and subdural empyemas (699), 422 (29.9%) underwent diagnostic LP prior to referral to our unit. The records of these 422 patients were studied in more detail with regard to the result of the LP and it's effect on patient outcome. Results of the LP were analysed in order to determine the contribution of LP to the diagnosis. The impact of the LP on patient outcome was assessed. Results: The cerebrospinal fluid (CSF) examination was normal in 66 (15.6%) and equivocal in 283 (67.1%). Bacterial meningitis was diagnosed in 73 (17.3%) and organisms cultured in 42 (10.0%). As suspected, 272 patients (64.5%) underwent clinical deterioration following lumbar puncture. In 81 patients (19.2%) the clinical deterioration was directly attributable to the lumbar puncture and 20 patients (4.7%) died as a result of LP. Conclusion: In patients with brain abscess or subdural empyema, LP contributes little to diagnosis while significantly increasing the risk of clinical deterioration and even death. Patients suspected of harbouring infective intracranial mass lesions should undergo computed tomography (CT) prior to LP or should be placed onto empiric antibiotic therapy until a CT scan can be obtained.
URI: http://hdl.handle.net/1807/22480
Other Identifiers: http://www.bioline.org.br/abstract?id=ns01004
Rights: Copyright 2001 - African Journal of Neurological Sciences
Appears in Collections:Bioline International Legacy Collection

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