Q: What is the appropriate initial study in a patient with headache, lethargy, nuchal rigidity and papilledema?
A: Computed tomography (CT) of the head should be done initially to exclude the presence of mass lesions prior to lumbar puncture.
The important consideration here is subarachnoid hemorrhage, secondary to a ruptured aneurysm. If meningitis is a possibility, administration of antibiotics should not be delayed.