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• W1978997372 abstract "Background Many authors have strongly cautioned against the performance of lumbar puncture in patients with suspected or likely infective intracranial mass lesions due to the dubious value of the CSF analysis so obtained, and due to the inherent danger of clinical deterioration precipitated by a pressure cone. Objective To assess the role of lumbar puncture (LP) in aiding diagnosis and influencing outcome in patients with intracranial brain abscess or subdural empyema. Methods The records of patients admitted with space occupying intracranial infective mass lesions (brain abscess and subdural empyema) to the neurosurgical unit at Wentworth Hospital, Durban, over a 15 year period, were retrospectively reviewed. Of the 1411 patients admitted with intracranial suppurative disorders (brain abscess = 712) and subdural empyemas (699), 422 (29.9%) underwent diagnostic LP prior to referral to our unit. The records of these 422 patients were studied in more detail with regard to the result of the LP and it's effect on patient outcome. Results of the LP were analysed in order to determine the contribution of LPto the diagnosis. The impact of the LP on patient outcome was assessed. Results The cerebrospinal fluid (CSF) examination was normal in 66 (15.6%) and equivocal in 283 (67.1%). Bacterial meningitis was diagnosed in 73 (17.3%) and organisms cultured in 42 (10.0%). As suspected, 272 patients (64.5%) underwent clinical deterioration following lumbar puncture. In 81 patients (19.2%) the clinical deterioration was directly attributable to the lumbar puncture and 20 patients (4.7%) died as a result of LP. Conclusion In patients with brain abscess or subdural empyema, LP contributes little to diagnosis while significantly increasing the risk of clinical deterioration and even death. Patients suspected of harbouring infective intracranial mass lesions should undergo computed tomography (CT) prior to LP or should be placed onto empiric antibiotic therapy until a CTscan can be obtained. Keywords: cerebrospinal fluid, intracranial brain abscess, lumbar puncture, subdural empyema, abcès intracrânien, empyéme sous-dural intra-crânien, liquide cérébro-spinal, ponction lombaire Résumé Introduction Plusieurs auteurs ont insisté sur le caractère inutile et dangereux de pratiquer une ponction lombaire (PL) lorsque l'on suspecte un processus expansif intracrânien d'origine infecteuse à cause du risque d'engagement. Objectif Evaluer le rôle de la PL au plan diagnostique et étudier son influence sur l'évolution des abcès et empyèmes sous - duraux intra-crâniens. Méthodes Les dossiers des patients hospitalisés pour des lésions infectieuses intracrâniennes pendant 15 ans et admis dans le département de neurochirurgie du Wentworth Hospital, Durban ont été étudiés rétrospectivement. Sur les 1411 patients hospitalisés pour suppuration intracrânienne (abcès cérébraux = 712) et empyèmes sous – duraux (699), 422 (29,9%) ont subi une PL avant d'être admis dans notre service. Les dossiers de ces 422 patients ont été étudiés. Résultats Le liquide cérébro-spinal (LCS) était normal dans 66 cas (15,6%) et équivoque dans 283 cas (67,1%). Une méningite bactérienne a été diagnostiquée dans 73 cas (17,3%) avec présence de germes dans 42 cas (10%). 272 patients (64,5%) eurent une détérioration clinique après la PL. Chez 81 patients (19,2%) l'aggravation clinique était en rapport avec la PL. 20 patients (4,7%) décédèrent à cause de la PL. Conclusion Chez les patients ayant un abcès ou un empyème sous - dural intra-crânien la PL accroit de façon significative le risque de détérioration clinique voire la mort. Tout patient suspect de processus expansif intra-crânien doit bénéficier du CT-scan avant de pratiquer une PLou devra béné - ficier d'un traitement antibiotique empirique avant la réalisation du CT-scan. Af J Neuro Sci: 2001 20(1)" @default.
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• W1978997372 date "2001-01-01" @default.
• W1978997372 modified "2023-10-14" @default.
• W1978997372 title "Lumbar Puncture in Brain Abscessor Subdural Empyema: Not an Innocuous Procedure (English)" @default.
• W1978997372 doi "https://doi.org/10.4314/ajns.v20i1.7521" @default.
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