Is lumbar puncture needed?
Because up to 30% of children with bacterial meningitis have a seizure, it is frequently taught that lumbar puncture (LP) is mandatory for children who have fever and seizure, because the convulsion may be the sole manifestation of bacterial meningitis. Data suggest, however, that this principle is excessively invasive. Green and colleagues reviewed over 500 consecutive cases of meningitis in children aged 2 months to 15 years. They found that meningitis was associated with seizures in 23% of cases, but all of these patients presented with signs in addition to the fever and seizure. Over 90% presented with significant sensorium change, and the others presented with nuchal rigidity or other straightforward indications for LP. No patients were found to have bacterial meningitis manifesting solely as a simple seizure. The authors concluded that commonly taught rules requiring LP in children with fever and seizure are unnecessarily restrictive.188 A retrospective study of pediatric patient
