Warning About Lumbar Puncture
・Lumbar puncture may be hazardous if the patient has focal neurological deficit (suggesting space-occupying lesion) or if fundoscopy shows papilloedema (raised intra-cranial pressure).
・In these circumstances, a CT scan should be done first prior to lumbar puncture, if available.
・If CT scan not available, better to start presumptive treatment with anti-TB drugs rather than risk lumbar puncture.
Diagnosis of TB Meningitis
in Areas with Limited Diagnostic Facilities
・If TB meningitis is suspected, always obtain chest x-ray (50% with TB meningitis have radiographic findings suggesting TB)
・If there is no focal neurologic deficit suggesting space-occupying lesion and there is experience with lumbar puncture, perform lumbar puncture
・CSF should be checked for AFB (and culture if possible)
・To increase diagnostic yield, examine a centrifuged sample for at least 30 minutes before calling negative
・Low threshold to initiate TB treatment without diagnosis and to refer to higher level facilities
