Detection of Xanthochromia in Cerebrospinal Fluid,

Chalmers, A H; Kiley, Michelle

doi:10.1093/clinchem/44.8.1740

Cited by 37 publications

(25 citation statements)

References 5 publications

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“…It is also important to realize that a positive result for xanthochromia (detected by any method) may result from any condition causing a high serum bilirubin, with repeated LP after a delay (where there is time for traumatically introduced blood to be metabolized) and with high CSF protein in the absence of SAH. 22 Time delay to analysis of CSF does not alter the concentration of bilirubin in the CSF; however, an increase in concentration of oxyHb has been demonstrated. 22 This may result in a falsely elevated xanthochromic index.…”

Section: Examination For Xanthochromiamentioning

confidence: 94%

Suspected subarachnoid haemorrhage with a negative CT head scan: What next?

Foot¹,

Merfield²

2000

Emergency Medicine

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The current recommended ‘next investigation’ for patients with a suspected subarachnoid haemorrhage and a negative non‐contrast computed tomography head scan, is a lumbar puncture. The cerebrospinal fluid obtained at lumbar puncture may be examined for the presence of blood and xanthochromia. Xanthochromia may be assessed by macroscopic examination or by spectrophotometry. Total red cell count and the three‐tube test have poor sensitivity and specificity as investigations for diagnosing subarachnoid haemorrhage. Macroscopic examination for xanthochromia is unreliable, with a risk of false‐negative results. Spectrophotometric examination for xanthochromia is associated with false positive results. The use of cerebrospinal fluid derivative spectroscopy and D‐Dimer testing using an enzyme‐linked immunosorbent assay need further evaluation. In the future, computed tomography angiography or magnetic resonance angiography may change current practice. Until then, all patients should be advised to have a lumbar puncture. A cerebrospinal fluid specimen obtained at least 8 h after the onset of headache and analysed for xanthochromia via spectrophotometry has the best chance of placing the patient in the lowest possible risk category. The emergency physician must be aware of the methods of cerebrospinal fluid analysis used locally.

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Section: Examination For Xanthochromiamentioning

confidence: 94%

Suspected subarachnoid haemorrhage with a negative CT head scan: What next?

Foot¹,

Merfield²

2000

Emergency Medicine

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“…They cite an example of xanthochromia CSF (determined by measuring the bilirubin as well) with absorption of 0.022 at 415 nm. 17 It should be noted that in their study, their goal was to detect xanthochromia in a time-insensitive manner. In traumatic SAH, bilirubin pigment should not be present early.…”

Section: Limitationsmentioning

confidence: 97%

Xanthochromia is not pathognomonic for subarachnoid hemorrhage

Graves¹

2004

Academic Emergency Medicine

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“…1 The presence of bilirubin resulting in yellow discolouration of the CSF is the contemporary definition for xanthochromia. 2 The finding of xanthochromia implies a SAH, a condition that is infrequent but has catastrophic morbidity and mortality if missed. 3 A cerebral angiogram in search of a treatable aneurysmal cause is indicated on finding xanthochromia or more specifically on detecting bilirubin in the CSF.…”

Section: Kevin H Chumentioning

confidence: 99%