Journal Article

The necessity of lumbar puncture in adult emergency patients with fever-associated seizures

Fujiwara, Satoru, Mizu, Daisuke, Huh, Ji-Young, Matsuoka, Yoshinori, Ariyoshi, Koichi, Kamitani, Yuka

2022

Overview

Central nervous system (CNS) infections are often suspected in adult patients with fever-associated seizures. However, it is unclear whether lumbar puncture (LP) is routinely required in patients with fever-associated seizures. This study aimed to examine the prevalence of meningitis and encephalitis in adult patients with fever-associated seizures and to evaluate whether LP is routinely required. We retrospectively studied patients aged ≥16 years who presented to the emergency department with complaints of seizures and fever above 37.5 °C who were admitted to the hospital between January 2017 and December 2019. LP was performed when the emergency physician suspected meningitis or encephalitis. Neurologists assessed patients with normal cerebrospinal fluid (CSF) findings and those admitted without LP after hospitalization. A neurologist confirmed the diagnoses of meningitis and encephalitis. The study included 148 patients. Ninety-seven patients (65.5%) were male, and the median age was 60 years. LP was performed in 105 patients (70.9%), and 14 (13.4%) had CSF pleocytosis. Meningitis and encephalitis were diagnosed in nine patients (6.1%), of whom four (2.8%) had CNS infections. Patients diagnosed with meningitis and encephalitis were more likely to have Glasgow Coma Scale <13 (P = 0.03) and less likely to have a history of seizures or epilepsy (P = 0.04) and had higher C-reactive protein levels than the other patients (P = 0.02). The prevalence of meningitis or encephalitis is relatively low in adult patients with fever-associated seizures. Lumbar puncture is considered unnecessary to be performed routinely, but its indication should be carefully considered with reference to the clinical course, comorbidities, and blood tests. Further validation studies with larger sample sizes are needed to confirm the findings of this study. •Central nervous system infections are emergency diseases causing seizures associated with fever.•The indications for LP in adult patients with seizures remain unclear.•The likelihood of meningitis and encephalitis is relatively low in adult patients with fever-associated seizures.•Lumbar puncture is not routinely necessary for adult patients with fever-associated seizures.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult patients / Blood tests / C-reactive protein / Central nervous system / Central nervous system infection / Cerebrospinal fluid / Comorbidity / Convulsions & seizures / Diagnostic tests / Electroencephalography / Emergency / Emergency medical care / Encephalitis / Epilepsy / Fever / HIV / Human immunodeficiency virus / Infections / Lumbar puncture / Medical imaging / Medical records / Meningitis / Neuroimaging / Patients / Pleocytosis / Polymerase chain reaction / Seizure / Seizures