Lumbar puncture in bacterial meningitis

Bacterial meningitis is diagnosed through testing of cerebrospinal fluid, which is obtained through lumbar puncture. In this thesis we investigated the practice and characteristics of lumbar puncture in adults with community-acquired bacterial meningitis identified in a prospective nationwide cohort study. This study collected data on patient’s history, symptoms and signs, laboratory findings, clinical course, treatment, and outcome. Lumbar puncture is a safe procedure in patients without contraindications. An absolute contraindication for lumbar puncture is brain shift, in which it can elicit fatal compression of brain structures. Clinical characteristics have been identified to predict which patients are at risk for having brain shift. In patients with any of these clinical characteristics cranial CT should be performed to check if performing lumbar puncture is safe. To prevent treatment delay, antibiotics and dexamethasone should be administered prior to sending the patient for imaging. We describe which percentage of patients with bacterial meningitis undergo a cranial CT prior to lumbar puncture in the Netherlands, and how this percentage was affected by the publication of a nationwide guideline on bacterial meningitis. Furthermore, we describe the interrater reliability of assessment of the cranial CT for contraindications for lumbar puncture by experts. We also describe the additional value of a repeat lumbar puncture later during the disease course of bacterial meningitis, and we describe lumbar puncture results in patients with cancer and bacterial meningitis. Last, we provide an overview of indications for lumbar puncture in other neurological diseases.