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Tuberculous-meningitis-autopsy, showing associated brain oedema and congestion. Diagnosis of TB meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture. When collecting CSF for suspected TB meningitis, a minimum of 1 ml of fluid should be taken (preferably 5 to 10 ml).
Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. [2] [8] A lumbar puncture, in which a needle is inserted into the spinal canal to collect a sample of cerebrospinal fluid (CSF), can diagnose or exclude meningitis. [1] [8]
Chronic meningitis is defined by signs and symptoms being present longer than four weeks and includes pleocytosis, or the presence of inflammatory cells in the cerebrospinal fluid. [2] The initial test is usually a lumbar puncture to collect cerebrospinal fluid for analysis.
Lumbar puncture in a child suspected of having meningitis Increased CSF pressure can indicate congestive heart failure , cerebral edema , subarachnoid hemorrhage , hypo-osmolality resulting from hemodialysis , meningeal inflammation, purulent meningitis or tuberculous meningitis, hydrocephalus , or pseudotumor cerebri . [ 27 ]
Lumbar puncture procedure for diagnosing aseptic meningitis. The term aseptic can be misleading, implying a lack of infection. On the contrary, many cases of aseptic meningitis represent infection with viruses or mycobacteria that cannot be detected with routine methods. Medical professionals will take into consideration the season of the year ...
As such, patient presentation of fever, headache, stiff neck, and altered mental status is not sufficient information for diagnosis and lumbar puncture must be performed to properly diagnose meningitis. [4] Cerebrospinal fluid findings in herpes meningitis present with lymphocytic pleocytosis, normal glucose, and normal-to-elevated protein. [8]
During the lumbar puncture procedure, the opening pressure is measured. A pressure of over 180 mm H 2 O is suggestive of bacterial meningitis. It is likely that Mollaret meningitis is underrecognized by physicians, and improved recognition may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission. [12]
Quincke's puncture" is a somewhat outdated eponym for lumbar puncture, [4] [5] used for the examination of the cerebrospinal fluid in numerous diseases such as meningitis and multiple sclerosis. In 1893 he described what is now known as idiopathic intracranial hypertension, which he labeled "serous meningitis". [6]
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