In children and adults*, the suspicion of meningitis (an inflammation of the meninges which is the coverings of the brain and spinal cord) may be raised by symptoms such as headache, neck stiffness or neck pain, eye pain with bright lights. Once there is a concern about meningitis, the best test is a lumbar puncture (LP).
This is a similar technique to an epidural or spinal anaesthetic - a needle is passed between the vertebrae (bones of the spine) and into the cerebro-spinal fluid (CSF) to take a sample. This sample of CSF can be sent for bacterial culture, fungal culture or PCR testing to look for viruses. It can also be analyzed for red cells, white cells, glucose and protein, all of which is very useful information for the doctors looking after the person with suspected meningitis.
Some people get a headache after a LP if some extra CSF leaks out, but this usually resolves with rest. If the hole does not close, a “blood patch” can be done, where some blood is injected to clot around the hole to help it close.
(*The situation with suspected meningitis is a bit different in babies, where they cannot tell us about their symptoms and where meningitis is relatively more common. Newborn babies have a leaky blood-brain barrier, so any infection in their blood can potentially pass through and cause meningitis. Therefore in newborn babies with fever, a LP is part of the standard investigations for a fever or suspected sepsis.)
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