Role of Lumbar Drainage as an Adjunct for Controlling Intracranial Pressure in Acute Bacterial Meningitis

Abstract: This case report describes a 16-year-old girl with fulminant bacterial meningitis in whom external ventricular drainage and intense volume-targeted therapy (the Lund protocol) was not sufficient to control intracranial pressure, but lumbar drainage on day 8 decreased the intracranial pressure immediately and led to a sustained low intracranial pressure level. The case is unusual and not fully understood, but the authors assume that due to inflammation and tissue reactions following aggressive infection, cerebrospinal fluid could not flow freely from the posterior fossa up to the ventricular drain. High pressure in the posterior compartment maintained the high intracranial pressure measured by the ventricular drain, and lumbar drain insertion caused an immediate fall in pressure. The lesson learned is that during an intracranial pressure crisis in a patient with open basal cisterns, a lumbar drain may be necessary because the cerebrospinal fluid space can be compartmentalized.