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> >Dr. Cordle wrote:
> >"Could it be that the LP just happened to be done at about the time
these
> >children were going to herniate?"
> >
> >I believe there is some truth to this statement. As Dr. Schexsnyder
(sorry
> >if I spelt it wrong Steve!!) and Dr's. Salik & Soglin said, some with
> >bacterial meninigitis have a progressively downhill course with eventual
> >demise regardless of whether an LP is done or not. We have all seen such
> >unfortunate events. In fact my colleague had a 3 week old with fulminant
> >GBS meningitis that lapsed into a flaccid coma with fixed dilated pupils
in
> >less thatn 12 hours just last week.
> >
> >I still speculate, as I said in my last posting, that it may be a
vascular
> >event at the brain stem level, because an open fontanelle should have
> >protected the neonate from  isolated "coning"???
> >
> >Randolph, to prove causality between LP and herniation/death, is
> >exceedingly difficult with prospective matched cohorts, given the
relative
> >infrequency of bacterial meningitis and  the even lesser frequency of
> >herniation (0-6%, as David Smith stated from his review of the data).
The
> >closest data I thought in the literature was the  retrospectively
matched
> >cohorts used by Rannick in BMJ (ref: my earliar posting) where a
suggestion
> >of an association was made based on temporal profiles. Archer's study in
> >CMAJ was just a review of previous retrospective (and conflicting!!)
data,
> >as well as opinions and surveys amongst neurologists in Canada...not
> >compelling at all.
> >
> >
> >Jay Pershad, MD
> >"Every noble thought in your mind brings you closer to God"
> >
> >----------
> >>
 
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