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Journal of Neurology
Published in: Journal of Neurology 6/2013

01-06-2013 | Original Communication

Differential diagnostic yield of lumbar puncture in investigation of suspected subarachnoid haemorrhage: a retrospective study

Authors: Anna Brunell, Peter Ridefelt, Johan Zelano

Published in: Journal of Neurology | Issue 6/2013

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Abstract

The diagnostic algorithm of computerized tomography (CT) and lumbar puncture (LP) for suspected subarachnoid haemorrhage (SAH) has lately been challenged by the advancement of radiological techniques, such as higher resolution offered by newer generation CT-scanners and increased availability of CT-angiography. A purely radiological workup of suspected SAH offers great advantages for both patients and the health care system, but the risks of abandoning LP in this setting are not well investigated. We have characterized the differential diagnostic yield of LP in the investigation of suspected SAH by a retrospective study. From the hospital laboratory database, we analyzed the medical records of all patients who had undergone CSF-analysis in search of subarachnoid bleeding during 2009–2011. A total of 453 patients were included. In 14 patients (3 %) the LP resulted in an alternative diagnosis, the most common being aseptic meningitis. Two patients (0.5 %) received treatment for herpes meningitis. Five patients (1 %) with subarachnoid haemorrhages were identified. Among these, the four patients presenting with thunderclap headache had non-aneurysmal bleedings and did not require surgical intervention. We conclude that the differential diagnostic yield of LP in investigation of suspected SAH is low, which indicates that alternative diagnoses is not a reason to keep LP in the workup when a purely radiological strategy has been validated. However, algorithms should be developed to increase the recognition of aseptic meningitis. One hundred and fifty-three patients (34 %) were admitted to undergo LP, which estimates the number of hospital beds that might be made available by a radiological diagnostic algorithm.
Literature
1.
2.
van der Wee N et al (1995) Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry 58(3):357–359PubMedCrossRef
3.
Byyny RL et al (2008) Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage. Ann Emerg Med 51(6):697–703PubMedCrossRef
4.
Westerlaan HE et al (2011) Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis–systematic review and meta-analysis. Radiology 258(1):134–145PubMedCrossRef
5.
Edlow JA, Caplan LR (2000) Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med 342(1):29–36PubMedCrossRef
6.
Network SIG (2008) Diagnosis and management of headache in adults a national clinical guideline. Scottish Intercollegiate Guidelines Network, Edinburgh
7.
Muhammed O et al (2010) Retrospective audit of the investigation of patients with suspected acute subarachnoid haemorrhage. J Med Imaging Radiat Oncol 54(4):339–346PubMedCrossRef
8.
Mehrotra P et al (2010) Investigation of subarachnoid haemorrhage: does the buck stop with CT? J Med Life 3(3):338–342PubMed
9.
Landtblom AM et al (2006) Thunderclap headache–mostly a benign condition. Investigation guidelines–subarachnoid hemorrhage should be excluded. Lakartidningen 103(37):2632–2634, 2637
10.
Perry JJ et al (2011) Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 343:d4277PubMedCrossRef
11.
Gee C et al (2012) Sensitivity of newer-generation computed tomography scanners for subarachnoid hemorrhage: a Bayesian analysis. J Emerg Med 43(1):13–18PubMedCrossRef
12.
McCormack RF, Hutson A (2010) Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? Acad Emerg Med 17(4):444–451PubMedCrossRef
13.
Canovas D et al (2012) Clinical outcome of spontaneous non-aneurysmal subarachnoid hemorrhage in 108 patients. Eur J Neurol 19(3):457–461PubMedCrossRef
14.
Edlow JA (2010) What are the unintended consequences of changing the diagnostic paradigm for subarachnoid hemorrhage after brain computed tomography to computed tomographic angiography in place of lumbar puncture? Acad Emerg Med 17(9):991–995 discussion 996–997PubMedCrossRef
15.
Ungerer JP et al (2004) Automated measurement of cerebrospinal fluid bilirubin in suspected subarachnoid hemorrhage. Clin Chem 50(10):1854–1856PubMedCrossRef
16.
Ahmed DS et al (2009) Quantitative determination of cerebrospinal fluid bilirubin on a high throughput chemistry analyzer. Clin Lab 55(7–8):283–288PubMed
17.
Britton M et al (1983) The diagnostic accuracy of CSF analyses in stroke. Acta Med Scand 214(1):3–13PubMedCrossRef
18.
Rahman M et al (2011) Spontaneous intracranial hypotension: dilemmas in diagnosis. Neurosurgery 69(1):4–14 discussion 14PubMedCrossRef
19.
Coats TJ, Loffhagen R (2006) Diagnosis of subarachnoid haemorrhage following a negative computed tomography for acute headache: a Bayesian analysis. Eur J Emerg Med 13(2):80–83PubMedCrossRef
20.
Horstman P et al (2012) Chance of aneurysm in patients suspected of SAH who have a ‘negative’ CT scan but a ‘positive’ lumbar puncture. J Neurol 259(4):649–652PubMedCrossRef
21.
Brown SC, Brew S, Madigan J (2011) Investigating suspected subarachnoid haemorrhage in adults. BMJ 342:d2644PubMedCrossRef
Metadata
Title
Differential diagnostic yield of lumbar puncture in investigation of suspected subarachnoid haemorrhage: a retrospective study
Authors
Anna Brunell
Peter Ridefelt
Johan Zelano
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Journal of Neurology / Issue 6/2013
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-013-6846-x

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