Value of Repeat Lumbar Puncture in the Differential Diagnosis of Meningitis

THE symptoms and signs of bacterial and aseptic meningitis may be similar, and thus the differential diagnosis usually cannot be made on clinical grounds. A critical determinant in differentiating bacterial from aseptic meningitis is evaluation of the cerebrospinal fluid at the time of initial examination of the patient. When pleocytosis exceeds 1000 cells per cubic millimeter and consists predominantly of polymorphonuclear leukocytes, suspicion of bacterial meningitis is heightened. If, in addition, the cerebrospinal-fluid glucose is less than 40 mg per 100 ml, or less than 66 per cent of a simultaneously obtained blood glucose, and is associated with the presence . . .