What is the recommended pre-LP step to ensure safety in suspected meningitis?

• A. Head CT
• B. EEG
• C. Lumbar puncture
• D. Blood culture

Answer: (A)

In suspected meningitis, the priority is to avoid causing brain herniation from increased intracranial pressure. A head CT is used before performing a lumbar puncture when there are red flags such as altered mental status, new focal neurological deficits, papilledema, seizures, or immunocompromise. The CT looks for mass lesions, edema, or other space-occupying processes that would make LP unsafe. If the scan doesn’t show contraindications, you can proceed with LP to obtain CSF. If a contraindication is found, manage those issues first and delay LP as needed, while starting broad-spectrum antibiotics and obtaining blood cultures promptly. EEG isn’t helpful for assessing LP safety, lumbar puncture is the procedure itself, and blood cultures, though important, don’t determine whether LP is safe to perform.