Contraindications to lumbar puncture:
(1) confident clinical diagnosis of meningococcal disease, with typical hemorrhagic rash
(2) drowsiness or impaired consciousness
• Glasgow coma scale < 13
• deteriorating Glasgow coma scores
• signs of raised intracranial pressure
(3) focal neurologic signs
(4) signs of raised intracranial pressure, including marked instability in blood pressure and heart rate
(5) evidence of septic shock, with signs of poor perfusion
(6) infection at the planned lumbar puncture site
(7) moderate to severe bleeding disorder
Additional notes:
(1) A normal CT scan does not exclude a raised intracranial pressure.
(2) If lumbar puncture is not performed and the patient has not improved within 24 hours despite therapy, then reassess the need for lumbar puncture.
