Potential Risk of Fatal Cerebral Herniation After Lumbar Puncture in Suspected CNS Infection

Lumbar puncture is important in the investigation of suspected CNS infection. However, there is genuine concern and controversy about the risk of cerebral herniation after lumbar puncture. CT scan brain is widely performed before lumbar puncture whenever raised intracranial pressure is suspected. The pros and cons of interposition of CT scanning before lumbar puncture pose a clinical dilemma and have led to confusion among paediatricians and even a delay in initiation of therapy. CT scan brain only provides structural information and is considered insensitive in the exclusion of raised intracranial pressure. Clinical signs, not a CT scan brain, are the best indicators of when to or when not to do lumbar puncture. To exercise caution, relevant questions need to be addressed before performing a lumbar puncture. Literature is reviewed regarding lumbar puncture and cerebral herniation. The aim is to formulate a rational approach in managing children with suspected CNS infection.