Table 4

Contraindications to lumbar puncture

Drowsiness or impaired consciousnessFalling conscious level, Glasgow coma scale of <13
Signs of septicaemic shockPoor perfusion, low BP, tachycardia
Clinical diagnosis of invasive meningococcal diseaseRapid onset illness, typical haemorrhagic rash
Signs of raised intracranial pressurePapilloedema, coma, abnormal posturing, abnormal pupillary responses, high BP, low pulse
Focal neurological signsOn clinical examination of cranial and peripheral nerves
Bleeding tendencyThrombocytopenic rash or excessive bruising—check platelets and clotting screen
Known haemophiliac—consult haematologist