Box 1.

Indications for brain imaging before lumbar puncture (LP) in suspected meningitis^a

Focal neurological signs

Presence of papilloedema^b

Continuous or uncontrolled seizures GCS12^c

^aTo exclude significant brain swelling or shift that may predispose to cerebral herniation post LP.
^bInability to view the fundus is not a contraindication to LP, especially in patients who have had a short duration of symptoms.
^cLumbar puncture without prior neuroimaging may be safe at levels below this.GCS = Glasgow Coma Score