Viral meningitis lumbar puncture

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Lumbar puncture is the most important specific diagnostic procedure for detecting viral meningitis and to exclude other causes of meningitis. It is indicated for all suspected patients of viral meningitis. The CSF findings in case of viral meningitis include high glucose concentration, normal or slightly high protein, increased number of lymphocytes and lactates level of <2.1 mmol/l. CT scan should be done before lumbar puncture procedure in the immune deficient patient or patients with increased intracranial pressure.^[1]^[2]

Lumbar puncture

Indicaitons of lumbar puncture

Lumbar puncture is indicated in all pateints with strong suspicion of meningitis for the following reasons:^[3]

To confirm the diagnosis
To differentiate the different causes of meningitis
To diagnose the specific causative agent for bacterial meningitis
To start the appropriate treatment as early as possible to prevent complications

Findings of lumbar puncture in viral meningitis

High count of white blood cells (10-100 cells/µL)
High glucose ratio (CSF/plasma) >0.6
Normal protein level but may be slightly elevated
Increased number of the lymphocytes > granulocytes
Lactate levels <2.1

Contraindications of lumbar puncture

Contraindications of lumbar puncture include the following:^[3]

Increased intracranial pressure
Mass lesion such as tumour
Thrombocytopenia
Bleeding diathesis

References

↑ Casasoprana A, Hachon Le Camus C, Claudet I, Grouteau E, Chaix Y, Cances C; et al. (2013). "[Value of lumbar puncture after a first febrile seizure in children aged less than 18 months. A retrospective study of 157 cases]". Arch Pediatr. 20 (6): 594–600. doi:10.1016/j.arcped.2013.03.022. PMID 23639837.
↑ Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
↑ ^3.0 ^3.1 Doherty CM, Forbes RB (2014). "Diagnostic Lumbar Puncture". Ulster Med J. 83 (2): 93–102. PMC 4113153. PMID 25075138.

[pmid23639837-1] Casasoprana A, Hachon Le Camus C, Claudet I, Grouteau E, Chaix Y, Cances C; et al. (2013). "[Value of lumbar puncture after a first febrile seizure in children aged less than 18 months. A retrospective study of 157 cases]". Arch Pediatr. 20 (6): 594–600. doi:10.1016/j.arcped.2013.03.022. PMID 23639837.

[pmid10654948-2] Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.

[pmid25075138-3] 3.0 ^3.1 Doherty CM, Forbes RB (2014). "Diagnostic Lumbar Puncture". Ulster Med J. 83 (2): 93–102. PMC 4113153. PMID 25075138.

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