Comments on: LP post-seizure – do white cells indicate infection?

By: yousef hijazi

yousef hijazi — Fri, 02 Mar 2012 12:20:19 +0000

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

By: Adrian Sie

Adrian Sie — Mon, 31 Oct 2011 15:17:45 +0000

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).

By: Ian Wacogne

Ian Wacogne — Mon, 06 Jun 2011 01:36:14 +0000

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.