Lumbar puncture and cerebrospinal fluid analysis

Welch, Henry; Hasbun, Rodrigo

doi:10.1016/s0072-9752(09)96003-1

Cited by 18 publications

(20 citation statements)

References 119 publications

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“…1 Glucose is mainly transported into the CSF by facilitation across the choroid plexus and the ventricular and subarachnoid capillary system while some of it is transported by simple diffusion. Current theories postulate that the pathogenesis of hypoglycorrhachia is multifactorial and includes inhibition of glucose entry into the subarachnoid spaces due to alterations in the blood brain barrier 6 , increased rate of glucose transport across the arachnoid villi, increased glycolysis by leucocytes and bacteria 17 and increased rate of metabolism in the brain and spinal cord.…”

Section: Discussionmentioning

confidence: 99%

“…1 The time between the serum glucose and the CSF glucose determination was considered concomitant if less than 60 minutes. 3 An adverse clinical outcome at time of discharge was determined by using the Glasgow outcome scale.…”

Section: Methodsmentioning

confidence: 99%

“…1,2 In order to have a reliable CSF to serum glucose ratio, the time between the two determinations should be done within 60 minutes of each other. 2 Hypoglycorrhachia is usually suggestive of bacterial, tuberculous and fungal meningitis but has been reported in other cases such as in viral/aseptic meningitis 4–7 , leptomeningeal carcinomatosis 8 , subarachnoid hemorrhage 9 , Lyme meningitis 10 , neurobrucellosis 11 , and neurosarcoidosis 12 .…”

Section: Introductionmentioning

confidence: 99%

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Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance

Shrikanth

Salazar

Khoury

et al. 2015

International Journal of Infectious Diseases

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Study objectives Hypoglycorrhachia (CSF glucose < 45mg/dL) has been identified as a prognostic factor in patients with meningitis. We analyzed the differential diagnosis of hypoglycorrhachia and its clinical significance. Methods Retrospective study of 620 adult patients with community acquired meningitis [CSF WBC >5 cells/mm3, absence of a CSF shunt or recent neurosurgical procedure (< 1 month)] at 8 Memorial Hermann Hospitals in Houston, TX from January, 2005 to December, 2010. An adverse clinical outcome was defined as a Glasgow outcome scale of 4 or less. Results Out of 620 patients with meningitis, 116 (19%) had hypoglycorrachia. Etiologies of hypoglycorrhachia were idiopathic (40), bacterial (27), cryptococcal (26), viral (15), and tuberculous (4). Patients with hypoglycorrachia were more likely to be immunosuppressed, have a history of intravenous drug use, and present with a vesicular or petechial rash, nausea or vomiting, nuchal rigidity, sinusitis/otitis, abnormal mental status and focal neurological deficits compared to those patients without hypoglycorrachia (p<0.05). Additionally, patients in the hypoglycorrhachia group had significantly higher rates of positive CSF and blood cultures, urgent treatable conditions and abnormal cranial imaging (p<005). Furthermore, patients with hypoglycorrachia had more adverse clinical outcomes [26 out of 116 (22.4%) vs. 45 out of 504 (8.9%)] (p< 0.001). Conclusion Hypoglycorrhachia has significant clinical and prognostic value in the evaluation of adult patients with community-acquired meningitis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance

Shrikanth

Salazar

Khoury

et al. 2015

International Journal of Infectious Diseases

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“…Thus, a seroma may result in overuse of antibiotics and subsequent increase in bacterial resistance and in unnecessary removal of breast implants. In some specialities, glucose consumption in synovial fluid and cerebrospinal fluid is used as a marker of bacterial infection [6,7]. It is unclear if the glucose concentration in seromas could be used in the same fashion.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there are no biochemical seroma markers of infection and thus a risk of over-use of antibiotics and subsequent bacterial resistance and of unnecessary removal of breast implants. In some medical disciplines glucose consumption in synovial fluid and cerebrospinal fluid is used as a marker of bacterial infection [6,7]. Previously, glucose concentration has been presumed to be similar in seroma, lymph, and plasma [4,5].…”

Section: Introductionmentioning

confidence: 99%

Glucose concentration in seromas after plastic surgery: A pilot study

Hansson

Malm

Freccero

2012

Journal of Plastic Surgery and Hand Surgery

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Previously, glucose concentration has been presumed to be similar in seroma, lymph, and plasma. However, there are few studies actually measuring glucose concentration in seroma. The aim of this pilot study was to determine if the glucose concentration in seroma is similar to that in plasma, as it has previously been presumed. Biochemical analysis of seroma was performed on 11 patients that had undergone plastic surgery. Fluid was taken from the drains between postoperative day 3 and 6. The median glucose concentration was 3.09 millimolar (mM) (range 2.25-3.89 mM). Glucose concentration in seroma does not seem to be similar to that of plasma and lymph that has previously been presumed. The result of this pilot study warrants further investigation to determine the span of normal glucose concentration, its development over time, its relation to plasma glucose concentration, and how it is affected by infection.

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