Bacterial meningitis... get a CT first due to signs of neurological deficit (R upper extremity + nystagmus). Otherwise lumbar puncture.

• Patient presenting with signs/symptoms concerning for meningitis vs. subarachnoid hemorrhage who also has signs of increased intracranial pressure and should therefore have a CT scan performed before a lumbar puncture
• Key idea: Optic fundi cannot be visualized = Papilledema = Increased intracranial pressure = Contraindication to lumbar puncture due to risk of cerebral herniation
• Key idea: Both meningitis and subarachnoid hemorrhage can lead to fever and signs of meningismus (pain with neck flexion, Kernig sign, etc.)

https://step-prep.org/tutoring/

Indications for CT scan before lumbar puncture: FAILS

• Focal neurological deficit (as in this patient)
• Altered mental status
• Intoxication
• Lesions in the brain near LP site
• Seizures