To the Editor—We thank Glimåker and Sjölin for their response [1]. Lumbar puncture (LP) is extremely helpful in patients with suspected bacterial meningitis and physicians should have a low threshold for LP in this setting [2]. A causal relationship between LP and herniation is indeed difficult to establish, as brain herniation also occurs during bacterial meningitis disease course irrespective of LP. However, we disagree that computed tomography (CT) is not indicated prior to LP in patients with suspected bacterial meningitis who present with severely impaired consciousness without clinical signs of cerebral herniation. Our data show that LP can be performed safely...

中文翻译：

---

回复Glimåker和Sjölin

致编辑-感谢Glimåker和Sjölin的回应[1]。腰椎穿刺（LP）对疑似细菌性脑膜炎的患者非常有帮助，在这种情况下，医师的LP阈值应较低。LP与疝气之间的因果关系确实很难建立，因为在细菌性脑膜炎的病程中，无论LP为何，脑疝均会发生。但是，我们不同意在疑似细菌性脑膜炎，意识严重受损而没有脑疝的临床表现的疑似细菌性脑膜炎患者中，在进行LP前不建议使用计算机断层扫描（CT）。我们的数据表明LP可以安全地执行...