Analysis of cerebrospinal fluid for xanthochromia versus modern computed tomography scanners in the diagnosis of subarachnoid haemorrhage: experience at a tertiary trauma referral centre

Abstract

Despite improved computed tomography scanning technology, cerebrospinal fluid xanthochromia interpretation aids in the definitive diagnosis of subarachnoid haemorrhage. When requested appropriately cerebrospinal fluid xanthochromia analysis remains a vital service as results impact on clinical decision making, especially when computed tomography scan results are equivocal and is also important in later presenting patients when computed tomography accuracy decreases.

Guidance is needed on which CT-negative patients should proceed to LP for exclusion of SAH

“…It was surprising that 5 out of 11 patients in their study, where initial CT head was negative but CSF xanthochromia was positive for bleed, were confirmed to have SAH. 1 Indeed, in one of these five patients, on second review of the CT scan, evidence of SAH was noted. With regard to the other four patients, the time from onset of symptoms to presentation at emergency department (ED) was between 4 h and 14 days (mean 62 h).…”

“…4 Together, these findings suggest that modern CT scanners do indeed have nearly 100% sensitivity in excluding SAH. Our assumption is that the findings of Goyale et al 1 may, in part be due to late presentation of patients (beyond 10 days of initial symptoms) to the ED. We agree with the conclusion that CSF xanthochromia remains a vital service but for screening of SAH rather than diagnosis.…”

“…As described by Goyale et al, 1 the role of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis for visual xanthochromia (and in the UK also for spectrophotometric detection of bilirubin) in cases of suspected subarachnoid haemorrhage (SAH) with nondiagnostic brain imaging has been a matter of conjecture over recent years. It is useful to know that there are some cases of aneurysmal SAH that are still diagnosed by CSF spectrophotometry, allowing vital treatment.…”

“…Aberdeen, UK We read with interest the study by Goyale et al 1 comparing the use of cerebrospinal fluid (CSF) xanthochromia analysis to modern computed tomography (CT) scanners in the diagnosis of subarachnoid haemorrhage (SAH). It was surprising that 5 out of 11 patients in their study, where initial CT head was negative but CSF xanthochromia was positive for bleed, were confirmed to have SAH.…”