Death following lumbar puncture (LP) is feared by physicians. Many opinions are 
found in literature on the question whether computed cranial tomography (CT) 
should be performed before LP, to prevent herniation. These opinions are mainly 
based on retrospective studies and pathophysiological reasoning. In this review 
the difficulties in the decision whether we should perform CT before LP are 
discussed. It is explained that the concept of "raised intracranial pressure" is 
confusing, and that the less ambiguous terms "brain shift" and "raised CSF 
pressure" should be used instead. Brain shift is a contraindication to LP, 
whether CSF pressure is raised or not, and whether papilloedema is present or 
not. Subsequently, recommendations are offered for indications to perform CT 
before LP, grouped according to the safety and clinical utility of LP.