Introduction Post-dural puncture headache (PDPH) is defined as an orthostatic headache that develops within the first few days after performing a spinal tap and it is related to extravasation of cerebrospinal fluid (CSF) into the epidural space, resulting in CSF hypovolemia and hypotension. The risk factors for PDPH are not yet fully understood. Objective To evaluate the risk of spontaneously reported PDPH according to the size and type of spinal tap needle. Methods A total of 4589 patients undergoing outpatient lumbar puncture (LP) were included. All CSF collections were performed at Senne Liquor Diagnostico, a laboratory specialized in CSF collection and analysis. Patients were instructed to report by telephone if they had orthostatic headache during the first 7 days after LP to the medical team of the laboratory. Patients with previous headache were instructed to report any change in the headache pattern during the same period. Needle gauge was classified into two groups: 1) 25G or less and 2) greater than 25G. Two types of needles were used and compared: 1) Pencil point and 2) Quincke. Comparisons of the percentages of spontaneous reports of PDPH were made using the chi-square test. Results 141 patients (3.07%) reported PDPH to the laboratory's medical team. Needles of 25G gauge or less were used in 31.8% of cases. The percentage of patients reporting PHD in the group of 25G or less needles was 1.9% versus 3.6% in the group of larger than 25G needles (P=0.003). Pencil point needles were used in 10.6% of cases. The percentage of PHD among pencil point group was 1.4% versus 3.2% in Quincke group (P=0.026). Conclusion 25G or finer gauge needles as well as pencil point type needles significantly reduced the risk of spontaneously reported PHD.

Pseudotumor cerebri is a syndrome that results from increased intracranial pressure. The main symptoms are headache, vision disturbances, and pulsatile tinnitus. Definitive diagnosis requires the presence of clinical and/or radiological signs of intracranial hypertension, high opening pressure on lumbar puncture (LP), and normal CSF constitution. Several studies have evaluated new contributions of CSF in the clinical evaluation and the in understanding of the pathophysiology of pseudotumor cerebri. Such studies have included the analysis of inflammatory biomarkers, adipokines, proteomic analysis, and CSF flow studies. In this review, we present the main results obtained so far and critically discuss the present status and the potential role of research involving the CSF in this condition. Based on current knowledge, it is possible to conclude that CSF research with new biomarkers has not yet provided information that can be employed in clinical practice at this moment. However, a better understanding of the constitution and dynamics of CSF circulation in patients with pseudotumor cerebri has brought some information about this condition and can potentially improve our knowledge about this condition in the future.

Introduction Post-dural punction headache (PDH) is defined as an orthostatic headache that develops within the first few days after performing a spinal tap and it is related to extravasation of cerebrospinal fluid (CSF) into the epidural space, resulting in hypovolemia and CSF hypotension. The risk factors for PDH are not yet fully understood.  Objective To evaluate the risk of spontaneously reported PDH according to the size and type of spinal tap needle. Methods A total of 4589 patients undergoing outpatient lumbar puncture were included. All CSF collections were performed at Senne Liquor Diagnostico, a laboratory specialized in CSF collection and analysis. Patients were instructed to report by telephone the onset of orthostatic headache during the first 7 days after the puncture to the medical team of the laboratory. Patients with previous headache were instructed to report any change in the headache pattern during the same period.  Needle gauge was classified into two groups: 1) 25G or less and 2) greater than 25G. Two types of needles were used and compared: 1) Pencil point and 2) Quincke.  Comparisons of the percentages of spontaneous reports of PDH were made using the chi-square test. Results 141 patients (3.07%) reported PHD to the laboratory's medical team. Needles of 25G gauge or less were used in 31.8% of cases. The percentage of patients reporting PHD in the group of 25G or less needles was 1.9% versus 3.6% in the group of greater than 25G needles (P=0.003). Pencil point needles were used in 10.6% of cases. The percentage of PHD among pencil point group was 1.4% versus 3.2% in Quincke group (P=0.026).  Conclusion 25G or finer gauge needles as well as pencil point type needles significantly reduced the risk of spontaneously reported PHD.  Key-words: Post-dural punction headache, Spinal Tap, Spinal Tap Needle.

Introduction: The FilmArray® meningitis/encephalitis is a multiplex polymerase chain reaction for identifying 14 agents of central nervous system (CNS) infections, including bacteria, Cryptococcus and viruses. In this study, we retrospectively evaluated the clinical utility of using this method. Methods: We retrospectively evaluated data from 101 patients with suspected CNS infection in which cerebrospinal fluid (CSF) was submitted to FilmArray® and its diagnostic usefulness was evaluated. Results: Thirty-six CSF samples (35.6%) had a positive FilmArray® result. Twenty-six (72.2%) cases were positive for enterovirus, six (16.67%) were positive for HHV-6, two were positive for Parechovirus (5.56%), HSV-1, HSV-2, Haemophilus and Listeria=1 (2.78%). Of these 36 CSF samples, 34 (94.44%) had altered cytobiochemical CSF findings and 2 (5.56%) had no CSF abnormalities. None of these etiological agents were identified by other methods. Conclusion: FilmArray® was able to identify neuroinfection etiology in cases in which other etiological identification methods did not reveal the causative agent. In two cases with positive FilmArray® the CSF general analysis was normal. Therefore, this method increases diagnostic sensitivity and allows an early identification of the etiological agent, contributing to the clinical management of CNS infections.

Introduction: The physical examination of the cerebrospinal fluid (CSF) is part of its routine evaluation and is easily performed as soon as CSF is obtained. However, its predictive value of CSF abnormalities is poorly known. Objective: In this study we evaluated the predictive value for CSF abnormalities leukocytes count among clear and colorless CSF in cases of suspected central nervous system (CNS) infection. Methods: We retrospectively evaluated data from CSF samples collected from suspected CNS infection that were classified as clear and colorless. This visual categorization was performed by the collector physician and by biomedical staff experienced in CSF analysis. The CSF cell count were considered normal when CSF white blood cells were up to 3 cells/mm3 , protein was below 45 mg/dL, glucose above 50 mg/dL, and lactate bellow 19.6 mg/ dL. The proportion of normal CSF and normal CSF parameters were recorded. Results: 34,434 CSF samples from suspected CNS infection were included. Of those, 22,960 were classified as clear and colorless (66.7%). Among clear and colorless CSF samples 13,137 (57.2%) had normal CSF cytology and biochemical findings. The probability of CSF abnormalities in the cytological and/ or biochemical examination in clear and colorless CSF samples obtained from patients with suspected CNS infection was 42.8%. Discussion: In this study, we showed a high frequency of cytological and/or biochemical abnormalities in clear and colorless CSF obtained from patients with suspected CNS infection. Conclusions: Viral infections and other inflammatory CNS diseases are among the conditions that may present with clear and colorless CSF. Therefore, a clear and colorless CSF in suspected CNS infections has a little predictive value for CSF abnormalities.

Introduction: The Meningitis/Encephalitis FilmArray is an automated multiplex polymerase chain reaction for identifying 14 central nervous system (CNS) care agents, including viruses, Cryptococcus, and bacteria. The following bacteria are tested: E. coli K1, H. influenzae, L. monocytogenes, N. meningitidis, S. agalactiae and pneumoniae. In this study we compared the performance of FilmArray® with conventional microbiological methods for bacterial meningitis. Methods: We retrospectively evaluated data from 903 patients with CNS infection manifested by the method. Results: 42 cases were positive for bacteria, E. coli K1=2, H. influenzae=7, L. monocytogenes=5, N. meningitidis=9, S. pneumoniae=20. Of these, only 14 (33.34%) were positive with conventional microbiological methods, including culture and/or bacterioscopy. Three patients were negative on FilmArray® and positive with other methods: 2 culture positive (S. intermedius and Micrococcus) and one Gram negative. All 28 cases positive only with FilmArray® adopted a cerebrospinal fluid infection pattern suggestive of bacterial meningitis: pleocytosis with neutrophilic predominance, increased protein and lactate, and hypoglycorrhachia. Conclusion: The study confirms previous data indicating that FilmArray® increases the sensitivity of etiological diagnosis of bacterial meningitis.

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