Sir.—Fischer et al noted that computed tomographic (CT) scanning has "increased the ease and accuracy of diagnosis..." of cerebral abscesses (Journal 1981;135:746-749). However, the presenting problems listed by the authors, ie, headache, neurological symptoms or signs, fever, and leukocytosis, are also consistent with acute bacterial meningitis. Because the diagnosis of meningitis is confirmed by examination of CSF,1-3 clinicians should not necessarily regard CT as the procedure of choice when faced with a child whose clinical picture may be consistent with either abscess or meningitis.
Physicians caring for such children may wish to use CT to ensure the safety of the lumbar puncture (LP) by ruling out the presence of a mass lesion, since lumbar puncture performed on a child with cerebral abscess poses the risk o[ill] CNS herniation.4-6 Such a diagnostic strategy may be appropriate in nonurgent situations; however, the potential for very rapid deterioration in meningitis