25M college student p/w worst headache of his life, fevers, chills, painful & stiff neck. PMH epilepsy. Off meds. Hasn't had a seizure in 10 years. No other significant past medical. Tachy, febrile, tachypnic, normal O2 sat. Positive nuchal rigidity on exam. Oriented, follows commands, no motor or gaze palsy. WBCs 14. Does he need a head CT before LP?
Click here for a JAMA Rational Clinical Exam piece on bedside dx of acute meningitis (can you trust Kernig and Brudzinski?), the study that established the CT before LP rules, and some useful cards from ALiEM's PV series to enhance your bedside recall of these rules.
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