Letters to the Editor Letters to the Editor will be published, if suitable, as space permits. Thev should not exceed 1,000 words (typed double space) in length, and max be subject to editing or abridgement. Should Lumbar Puncture Be Part of the Routine Ev

To the Editor: 1 read with interest the recommendations of the Cerebral Embolism Study Group on the treatment of stroke due to cardiac emboli (Stroke 15:779-789. 1984). The authors state that they do not routinely recom-mend cerebrospinal examination prior to anticoagulation. I disagree. Failure to perform routine lumbar puncture in patients with stroke due to suspected cardiac emboli can result in a missed opportunity to make an early diagnosis of septic embolism from bacterial endocarditis. Stroke is a presenting symptom of bacterial endocarditis in 10-20 % of cases.1- 2- 3 Fever and other peripheral manifestations of septic embo-lism, although common, are not invariably present.'-2 Lumbar punc-ture performed in patients with cerebral emboli due to bacterial endocar-ditis is abnormal in three-quarters of cases with pleocylosis present in almost half.2-3 In contrast, cerebrospinal fluid pleocytosis after non-septic embolic infarcts is rare.4 Lumbar puncture is a safe procedure easily performed at the bedside. It provides valuable information and should be part of the routine evaluation of patients with suspected ischemia or infarction