Jellema Korné
Haaglanden Medisch Centrum, afd. Neurologie, Den Haag.
Contact: K. Jellema (
Ned Tijdschr Geneeskd. 2019 Feb 7;163:D3601.
A lumbar puncture (LP) is often essential for the diagnosis of bacterial meningitis. An LP can worsen brain displacement in case of a space-occupying lesion. Therefore, in selected patients a CT scan of the brain is made prior to performing the LP. However, the level of agreement between experts in diagnosing a contraindication for LP on CT scan is low. More importantly, in a substantial part of patients, empirical treatment with antibiotics was delayed due to the CT scan being performed first. The only effective treatment for patients with bacterial meningitis is early administration of antibiotics. Therefore, delay in administrating antibiotics should be prevented. Thus, should a CT scan of the brain be indicated, antibiotic treatment should be started before said imaging diagnostics and/or a potential LP procedure.
腰椎穿刺（LP）对于细菌性脑膜炎的诊断通常至关重要。在存在占位性病变的情况下，腰椎穿刺可能会加重脑移位。因此，对于部分选定的患者，在进行腰椎穿刺之前需先进行脑部CT扫描。然而，专家们在通过CT扫描诊断腰椎穿刺禁忌证方面的一致性较低。更重要的是，在相当一部分患者中，由于首先进行了CT扫描，抗生素的经验性治疗被延迟。对细菌性脑膜炎患者唯一有效的治疗方法是早期使用抗生素。因此，应避免抗生素给药的延迟。所以，如果需要进行脑部CT扫描，应在上述影像诊断和/或可能的腰椎穿刺操作之前开始抗生素治疗。
