CT before lumbar puncture

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5% had mass effect on ct

- pts with abnormal cts:

--- age >60,immunecompromised, cns dz, sz within one wk, aloc, unable to answer questions, unable to follow

commands, gaze palsy, abnrm visual fields, arm/ leg

drift, abnrml speech.

- features not assoc with abnormal ct- race,

insurance, htn, h/o parameningeal dz like otitis/

sinusitis

- if none of the above, chance of normal ct is 97%

- even if do lp with mildly abnormal ct, none had

brain herniation

- ct before lp resulted in longer ER stay and delay in

abx

- if no abnormal findings, neg predictive value is 97% - so don't need ct routinely

- if have abnormal finding, abx first, then ct then lp


7/2/09 PANI