Contraindications to lumbar puncture
| Category | Criteria/signs |
|---|---|
| Drowsiness or impaired consciousness | Falling conscious level, Glasgow coma scale of <13 |
| Signs of septicaemic shock | Poor perfusion, low BP, tachycardia |
| Clinical diagnosis of invasive meningococcal disease | Rapid onset illness, typical haemorrhagic rash |
| Signs of raised intracranial pressure | Papilloedema, coma, abnormal posturing, abnormal pupillary responses, high BP, low pulse |
| Focal neurological signs | On clinical examination of cranial and peripheral nerves |
| Bleeding tendency | Thrombocytopenic rash or excessive bruising—check platelets and clotting screen |
| Known haemophiliac—consult haematologist |