CT before LP?

If you think CT will show a cause for the headache, do a CT If a CT is indicated for other reasons (depressed conscious level, focal neurology), do a CT If a GCS 15 patient is to undergo LP for suspected (or to rule out) meningitis, and they have a normal neurological exam (including fundi), […]


CNS infection should be considered in all patients with a headache, neck stiffness, fever, altered sensorium, or diffuse or focal neurological findings. pneumoniae is one of the two leading causes of bacterial meningitis in adults. Mortality from S. pneumoniae is 30%. pay close attention to cranial nerves 2, 3, 4, and 6 Altered mental status […]

Tips for Interpreting the CSF Opening Pressure

The normal range for CSF is reported differently in various sources, with most reporting a normal range of 7-18 cmH2O in adults, though some consider the normal range 5-25 cmH2O. However, a pressure >25 cmH2O or <5 cmH2O should certainly prompt you to look for a source.  

How to… lumbar puncture in children

With the child in an appropriate position a line drawn between the most superior aspect of both Iliac crests (Tuffier’s line) crosses the midline over the body of L4 so the space just below this is ideal.

Emergency Medicine Kenya Foundation