For suspected meningitis, which diagnostic test should be performed first?

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Multiple Choice

For suspected meningitis, which diagnostic test should be performed first?

When meningitis is suspected but there are signs that raise concern for increased intracranial pressure or a mass effect, safety takes precedence over immediate CSF analysis. A CT scan is done first to quickly identify any mass effect, hydrocephalus, or other contraindications to performing a lumbar puncture. If the CT shows no contraindication, you can then proceed with a lumbar puncture to obtain CSF for analysis. Meanwhile, draw blood cultures and start empiric antibiotics if meningitis is strongly suspected, especially if there will be a delay before LP. The imaging step protects against the risk of brain herniation that can occur if LP is performed when intracranial pressure is high.

When meningitis is suspected but there are signs that raise concern for increased intracranial pressure or a mass effect, safety takes precedence over immediate CSF analysis. A CT scan is done first to quickly identify any mass effect, hydrocephalus, or other contraindications to performing a lumbar puncture. If the CT shows no contraindication, you can then proceed with a lumbar puncture to obtain CSF for analysis. Meanwhile, draw blood cultures and start empiric antibiotics if meningitis is strongly suspected, especially if there will be a delay before LP. The imaging step protects against the risk of brain herniation that can occur if LP is performed when intracranial pressure is high.

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