If you have CNS mass or high ICP, removal of CSF can cause herniation
CT Before LP
Papilledema
Seizures within 1 week
Focal Neuro Defecits
Age >60
Obtunded or Unconscious
Immunocompromised
History of CNS Disease
How do you interpret the LP?
Glucose
Protein
WBC
CSF
Gram Stain
Culture
Additional Tests
Acid fast stain
HSV PCR
Specific Bugs: West Nile, VZV, etc
Empiric Antibiotics
A(intubate)
B
C
Dexamethasone 0.15mg/kg q6h x 4 days
Should be before or with Abx (ideally 20-30 min before). Evidence Limited but some support decreased rates of hearing loss, neuro complications, mortality benefit.