Fast Five Quiz: What Do You Know About Meningitis?

Michael Stuart Bronze, MD

Disclosures

May 06, 2021

A CT scan of the head may be performed before lumbar puncture to determine the risk for herniation. However, the decision to obtain a brain CT scan before lumbar puncture should not delay the institution of antibiotic therapy; such delay can increase mortality. CT scan is often normal in uncomplicated meningitis, but it should also be noted that herniation can occur even in patients with bacterial meningitis who have a normal brain CT scan. The most reliable clinical signs that indicate the risk for herniation include deteriorating level of consciousness, brainstem signs, and a very recent seizure.

In general, CT of the head and MRI of the brain generally do not advance the diagnosis of meningitis. Some patients may show meningeal enhancement, but its absence does not rule out meningitis. Also, obtaining CT scans of the head may delay diagnostic lumbar puncture and the initiation of antibiotic therapy; the latter may be detrimental to the outcome in these patients.

Learn more about the workup for meningitis.

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