Should lumbar puncture be part of the routine evaluation of patients with cerebral ischemia?

Should Lumbar Puncture Be Part of the Routine Evaluation of Patients with Cerebral Ischemia? To the Editor: 1 read with interest the recommendations of the Cerebral Embolism Study Group on the treatment of stroke due to cardiac emboli (Stroke 15:779-789. 1984). The authors state that they do not routinely recommend cerebrospinal examination prior to anticoagulation. I disagree. Failure to perform routine lumbar puncture in patients with stroke due to suspected cardiac emboli can result in a missed opportunity to make an early diagnosis of septic embolism from bacterial endocarditis. Stroke is a presenting symptom of bacterial endocarditis in 10-20% of cases.3 Fever and other peripheral manifestations of septic embolism, although common, are not invariably present.'Lumbar puncture performed in patients with cerebral emboli due to bacterial endocarditis is abnormal in three-quarters of cases with pleocylosis present in almost half.In contrast, cerebrospinal fluid pleocytosis after nonseptic embolic infarcts is rare. Lumbar puncture is a safe procedure easily performed at the bedside. It provides valuable information and should be part of the routine evaluation of patients with suspected ischemia or infarction.