You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

LP post-seizure – do white cells indicate infection?

5 Jun, 11 | by Bob Phillips

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?

By submitting your comment you agree to adhere to these terms and conditions
  • 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 .

You can follow any responses to this entry through the RSS 2.0 feed.
ADC blog homeapage

ADC Online

Education, debate, and meandering thoughts on child health, using evidence and research.Visit site

Creative Comms logo

Latest from Archives of Disease in Childhood

Latest from Archives of Disease in Childhood