Indications for Lumbar Puncture and Cerebrospinal Fluid Analysis in Patients with Suspected Meningitis

Introduction

Meningitis is a life-threatening condition characterized by inflammation of the meninges surrounding the brain and spinal cord. Early diagnosis and management are crucial for reducing morbidity and mortality.

Why Perform a Lumbar Puncture?

• To confirm the diagnosis of bacterial, viral, fungal, or tuberculous meningitis.
• To assess cerebrospinal fluid (CSF) parameters such as glucose, protein, and white cell count.
• To identify the causative pathogen through microbiological tests.
• To rule out other neurological conditions such as subarachnoid hemorrhage or autoimmune encephalitis.

Clinical Indications

Physicians consider lumbar puncture in patients presenting with:

• Fever, headache, neck stiffness, and photophobia.
• Altered mental status, confusion, or seizures.
• Neurological symptoms suggestive of central nervous system infection.

Contraindications

• Signs of raised intracranial pressure (papilledema, severe hypertension, focal neurological deficits).
• Coagulopathy or thrombocytopenia increasing risk of bleeding.
• Suspected spinal cord mass or infection.

CSF Analysis

Key parameters evaluated include:

• Cell count and differential.
• Protein and glucose levels.
• Gram stain and bacterial culture.
• Polymerase chain reaction (PCR) for viral pathogens.

Conclusion

Timely lumbar puncture and CSF analysis are essential for diagnosing meningitis, guiding antimicrobial therapy, and improving patient outcomes.