Description
One of the commonest requests for out of hours
imaging is for cranial CT in patients with possible
meningitis. Telephone conversations like this may
be familiar:
“Hello I’m the medical SHO on call….I’d like to
request a CT brain please…to rule out raised intracranial
pressure before lumbar puncture…no we couldn’t get a good
look at his fundi….they didn’t have any tropicamide in A
and E…well, perhaps you’d like to do the LP if you don’t
think a CT is necessary…”
This type of request in fact may or may not be
justified depending on the clinical scenario. The
perception of radiologists is that few patients with
possible meningitis require head CT before lumbar
puncture; the perception of physicians is that the
majority do. Pole-positions like this invariably
generate conflict between our specialities. Can we
use the available literature to guide us to a more
evidence-based approach which both groups will
find acceptable ?
