Death following lumbar puncture (LP) is feared by physicians. Many opinions are found in literature on the question whether
computed cranial tomography (CT) should be performed before LP, to prevent herniation. These opinions are mainly based on
retrospective studies and pathophysiological reasoning.
In this review the difficulties in the decision whether we should perform CT before LP are discussed. It is explained that
the concept of “raised intracranial pressure” is confusing, and that the less ambiguous terms “brain shift” and “raised CSF
pressure” should be used instead. Brain shift is a contraindication to LP, whether CSF pressure is raised or not, and whether
papilloedema is present or not. Subsequently, recommendations are offered for indications to perform CT before LP, grouped
according to the safety and clinical utility of LP.
Key words spinal puncture - intracranial pressure - cerebrospinal fluid pressure - herniation of the brain - computed tomography
Received: 28 May 2001, Accepted: 24 July 2001