Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits.

OBJECTIVE: To determine the indications, if any, for routine computed tomography (CT) of the brain before lumbar puncture in the management of acute meningitis. DATA SOURCES: Original research papers, reviews and editorials published in English from 1965 to 1991 were retrieved from MEDLINE. The bibliographies of these articles and of numerous standard texts were examined for pertinent references. A survey of local neurologists was conducted, and legal opinion was sought from the Canadian Medical Protective Association. DATA EXTRACTION: There were no studies directly assessing the risks of lumbar puncture in meningitis; however, all sources were culled for other pertinent information. RESULTS: No cases could be found of patients with acute meningitis deteriorating as a result of lumbar puncture. The neurologic consensus refuted the need for CT in typical acute meningitis. All sources stressed speedy lumbar puncture and the early institution of appropriate antibiotic therapy to minimize the severity of the illness and the risk of death. CONCLUSIONS: (a) There is no evidence to recommend CT of the brain before lumbar puncture in acute meningitis unless the patient shows atypical features, (b) for patients with papilledema the risks associated with lumbar puncture are 10 to 20 times lower than the risks associated with acute bacterial meningitis alone, (c) CT may be necessary if there is no prompt response to therapy for meningitis or if complications are suspected, (d) the inability to visualize the optic fundi because of cataracts or senile miosis is not an indication for CT and (e) there are no Canadian legal precedents suggesting liability if physicians fail to perform CT in cases of meningitis.     

Computed tomography in the investigation of dementia.

To assess the value of computed tomography in investigating patients with dementia, 500 consecutive patients presenting with a provisional clinical diagnosis of dementia of recent onset were reviewed and the results analysed in a computer. Most patients had either cerebral atrophy or infarction, but 82 patients had a normal scan and 42 others had tumours. More than 10% of all patients, including 5% with no other symptoms or signs, had a treatable lesion. Various associated symptoms and signs were useful pointers to such a treatable lesion and clearly indicated computed tomography. Accurate diagnosis is the cornerstone of proper management, and if a few patients with treatable lesions can be identified then the benefits to all concerned may be incalculable.     

Computed tomography in the diagnosis of pathological states of the lumbar diaphragm. 2: diseases of the diaphragm]

CT potentialities in the diagnosis of diaphragmatic diseases were considered. CT provides valuable information in relaxations of the diaphragm and diaphragmitides, permitting the detection of infiltration of the diaphragm by a tumor, retroperitoneal fibrosis, diaphragmatic cysts, Bochdalek's hernia, and hernias of the esophageal opening. An algorithm for investigation of patients with suspected diaphragmatic pathological conditions was proposed.     

Computed tomography in the diagnosis of pathological states of the lumbar diaphragm. 1: general data. Developmental defects and traumatic disorders]

CT was employed for investigation of 94 patients with pathological changes of the diaphragm. Congenital defects and unilateral aplasia of the diaphragm were observed in 5 of them. A new symptom of a pathological line of the diaphragm was recognized, characteristic for this type of patients. Teratodermoid formations with a typical CT picture were found in 3 patients. A tumor growth source was undetectable by CT. The results of investigation of 5 patients with traumatic diaphragmatic hernia have shown no particular advantages of CT over traditional radiation methods. In one case, a traumatic diaphragmatic cyst was correctly diagnosed by CT. CT was shown to be a method of choice in the diagnosis of congenital and traumatic diaphragmatic lesions.