Table 1

Contraindications for lumbar puncture in suspected acute bacterial meningitis9

Signs suggesting raised intracranial pressure
 Reduced or fluctuating level of consciousness (Glasgow coma scale score <9 or a drop of 3 or more)
 Relative bradycardia and hypertension
 Focal neurological signs
 Abnormal posture or posturing
 Unequal, dilated, or poorly responsive pupils
 Abnormal ‘doll's eye’ movements
Extensive or spreading purpura
Coagulation abnormalities
 Coagulation results (if obtained) outside the normal range
 Platelet count below 100×109/litre
 Receiving anticoagulants
Local superficial infection at the lumbar puncture site
Respiratory insufficiency