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Previous Volume 354:1429-1432 March 30, 2006 Number 13 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: In their review article on community-acquired bacterial meningitis (Jan. 5 issue), van de Beek et al.¹ suggest that when bacterial meningitis is probable but neuroimaging is not available, lumbar puncture should be given preference in immunocompromised patients or in those with moderate-to-severe impairment of consciousness.

As emergency physicians, we frequently encounter patients with altered consciousness and findings compatible with bacterial meningitis. Lumbar puncture can be performed safely without neuroimaging in selected patients. However, in those with severely impaired consciousness, a reliable neurologic examination is difficult and there is increased likelihood of clinically significant intracranial lesions, including those . . . [Full Text of this Article]

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