Q: Why ophthalmic exam is necessary for patients suspected of meningitis?


Answer: If papilledema is evident on ophthalmic exam, CT scan of head should be performed before lumbar puncture. Usually CT scan of head is not required before performing LP in patients suspected of meningitis, but in few situations, it should be done in following and other situations

•  history of HIV 
•  Patients on immunosuppressive therapy,
• history of solid organ or hematopoietic stem cell transplantation
• history of central mass lesion
• new onset seizure
• papilledema
• focal deficit

References: 

1.  Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001; 345:1727. 

2. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267.