LP post-seizure – do white cells indicate infection?

Obviously, I’m excluding the rather large proportion of my workload where the presence of white cells in the CSF indicate metastatic disease … but in normal children, if you did an LP on a child after a seizure and got a total white cell count of 19, would you be treating for meningitis?

I have to say, I would. But there are a team from Australia that are considering the question: until then, what will you be doing?

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  • Good question.  While they're at it, do they want to try to track down the original for “You're allowed 10 cells in your CSF” thing – because I have no idea where it came from, and the number 10 is far too round for my liking.

    I guess, however, in the context of this clinical question, I'd be thinking more along the lines of the consequences of not treating, rather than of treating.  What I mean is, I'd have to be very convinced of the true negativity of this number of white cells before I'd change my practice.

  • Adrian Sie

    But why would you want to LP? If it's a typical generalized tonic clonic seizure in a previously well child with clear focus of infection, then you wouldn't bother.  On the other hand, if the child was strangely lethargic and quiet for a period before hand, if the seizure was more tonic posturing and/or asymmetrical, then you would be very keen to LP and you would have a low threshold for treating with antibiotics/antivirals.  You would also want to take your glucose and protein into account.  The articles by AI Riordan, AJ Cant; Arch Dis Child 2002;87:235-237 PMID 12193440; Carroll, Brookfield; Arch Dis Child 2002;87:238-240 PMID 12193441 are a good basis for discriminating febrile convulsions from meningitis.
    The issue of whether or not convulsions cause white cell elevation was dealt with by
    Wong M et al, J Pediatr. 2001 Mar;138(3):373-7.PMID: 11241045 who found max WCC is 8 and Protein 0.5 (although up to 55% neutrophils seen).

  • yousef hijazi

    I would treat it as meningitis
    because if it is meningitis and not treated the cmplication are horrible .