Haem Derivatives in the Cerebrospinal Fluid after Intracranial Haemorrhage

Wahlgren, N-G; Lindquist, C.

doi:10.1159/000116339

Cited by 34 publications

(15 citation statements)

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“…Beyond 4 days after SAH onset, conversion of oxyhemoglobin to methemoglobin increases gradually. 13,14 Methemoglobin is a paramagnetic substance that causes substantial T1 shortening. Therefore, methemoglobin accumulation causes T1 shortening in the subacute and chronic phases, 15 and T1WI is useful for SAH diagnosis in these phases.…”

Section: Neuroradiologic Diagnosis Of Minor Leak Before Major Attackmentioning

confidence: 99%

Neuroradiologic Diagnosis of Minor Leak prior to Major SAH: Diagnosis by T1-FLAIR Mismatch

Oda

Shimoda

Hirayama

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In major SAH, the only method to diagnose a preceding minor leak is to ascertain the presence of a warning headache by interview; however, poor clinical condition and recall bias can cause inaccuracy. We devised a neuroradiologic method to diagnose previous minor leak in patients with SAH and attempted to determine whether warning (sentinel) headaches were associated with minor leaks before major SAH.

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Section: Neuroradiologic Diagnosis Of Minor Leak Before Major Attackmentioning

confidence: 99%

Neuroradiologic Diagnosis of Minor Leak prior to Major SAH: Diagnosis by T1-FLAIR Mismatch

Oda

Shimoda

Hirayama

et al. 2015

AJNR Am J Neuroradiol

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“…Normally, methaemoglobin is present in very small amounts, but it has been reported in CSF of patients with subdural haematoma or an enclosed bleeding, giving the CSF a brownish color [38]. A spontaneous oxidation of the haem group occurs around 10 days after a bleed, irrespective of cause [39], which may be useful to distinguish between a traumatic tap and a cerebral haemorrhage [40].…”

Section: +mentioning

confidence: 99%

Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?

Nagy

Skagervik

Tumani

et al. 2013

Clinical Chemistry and Laboratory Medicine (CCLM)

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Subarachnoid haemorrhage (SAH) has a high mortality and morbidity rate. Early SAH diagnosis allows the early treatment of a ruptured cerebral aneurysm, which improves the prognosis. Diagnostic cerebrospinal fluid (CSF) analyses may be performed after a negative computed tomography scan, but the precise analytical methods to be used have been debated. Here, we summarize the scientific evidence for different CSF methods for SAH diagnosis and describe their implementation in different countries. The principle literature search was conducted using PubMed and Scopus with the search items "cerebrospinal fluid", "subarachnoid haemorrhage", and "diagnosis". CSF analyses for SAH include visual examination, red blood cell counts, spectrophotometry for oxyhaemoglobin or bilirubin determination, CSF cytology, and ferritin measurement. The methods vary in availability and performance. There is a consensus that spectrophotometry has the highest diagnostic performance, but both oxyhaemoglobin and bilirubin determinations are susceptible to important confounding factors. Visual inspection of CSF for xanthochromia is still frequently used for diagnosis of SAH, but it is advised against because spectrophotometry has a superior diagnostic accuracy. A positive finding of CSF bilirubin is a strong indicator of an intracranial bleeding, whereas a positive finding of CSF oxyhaemoglobin may indicate an intracranial bleeding or a traumatic tap. Where spectrophotometry is not available, the combination of CSF cytology for erythrophages or siderophages and ferritin is a promising alternative.

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“…7 Bilirubin arises only in vivo which makes it the most specific metabolite for distinguishing a true bleed from a traumatic tap. [7][8][9][10][11][12][13][14] In fact, the presence of bilirubin in the CSF taken 6-12 hours after ictus in a patient with suspected SAH is virtually a fail-proof diagnostic.…”

Section: The Clinical Relevance Of Csf Pigment Analysismentioning

confidence: 99%

Spectrophotometry for Cerebrospinal Fluid Pigment Analysis

Petzold

Sharpe²,

Keir³

2006

NCC

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The use of spectrophotometry for the analysis of the cerebrospinal fluid (CSF) is reviewed. The clinically relevant CSF pigments -oxyhemoglobin and bilirubin -are introduced and discussed with regard to clinical differential diagnosis and potentially confounding variables (the four "T"s or: traumatic tap, timing, total protein and total bilirubin). The practical laboratory aspects of spectrophotometry and automated techniques are presented in the context of analytical and clinical specificity and sensitivity. The perceptual limitations of human color vision are highlighted and the use of visual assessment of the CSF is discouraged in light of recent evidence from a national audit in the United Kingdom. Finally, future perspectives including the need for longitudinal CSF profiling and routine spectrophotometric calibration are outlined.

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Haem Derivatives in the Cerebrospinal Fluid after Intracranial Haemorrhage

Cited by 34 publications

References 0 publications

Neuroradiologic Diagnosis of Minor Leak prior to Major SAH: Diagnosis by T1-FLAIR Mismatch

Neuroradiologic Diagnosis of Minor Leak prior to Major SAH: Diagnosis by T1-FLAIR Mismatch

Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?

Spectrophotometry for Cerebrospinal Fluid Pigment Analysis

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