Abstract Sir.—Fischer et al noted that computed tomographic (CT) scanning has "increased the ease and accuracy of diagnosis..." of cerebral abscesses (Journal 1981;135:746-749). However, the presenting problems listed by the authors, ie, headache, neurological symptoms or signs, fever, and leukocytosis, are also consistent with acute bacterial meningitis. Because the diagnosis of meningitis is confirmed by examination of CSF,1-3 clinicians should not necessarily regard CT as the procedure of choice when faced with a child whose clinical picture may be consistent with either abscess or meningitis. Physicians caring for such children may wish to use CT to ensure the safety of the lumbar puncture (LP) by ruling out the presence of a mass lesion, since lumbar puncture performed on a child with cerebral abscess poses the risk o[ill] CNS herniation.4-6 Such a diagnostic strategy may be appropriate in nonurgent situations; however, the potential for very rapid deterioration in meningitis References 1. Hambleton G, Davies PA: Bacterial meningitis: Some aspects of diagnosis and treatment . Arch Dis Child 1975;50:674-684.Crossref 2. Feigin RD: Acute bacterial meningitis beyond the neonatal period , in Vaughan VC, McKay RJ, Behrman RE (eds): Textbook of Pediatrics , ed 11. Philadelphia, WB Saunders Co, 1981, pp 720-726. 3. Krugman S, Katz SL: Infectious Diseases of Children , ed 7. St Louis, CV Mosby Co, 1981, pp 168-183. 4. Petito F, Plum F: The lumbar puncture . N Engl J Med 1974;290:225-227.Crossref 5. Garfield J: Management of supratentorial intracranial abscess: A review of 200 cases . Br Med J 1969;2:7-11.Crossref 6. Bell EW: Brain abscess , in Swaiman KF, Wright FS (eds): The Practice of Pediatric Neurology . St Louis, CV Mosby Co, 1981, pp 168-183. 7. Wehrle PF, Mathies AW Jr, Leedom JM: The critically ill child: Management of acute bacterial meningitis . Pediatrics 1969;44:991-998. 8. Feigin RD, Dodge PR: Bacterial meningitis: Newer concepts of pathophysiology and neurologic sequelae . Pediatr Clin North Am 1976; 23:541-556.
American Journal of Diseases of Children – American Medical Association
Published: Mar 1, 1982
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