Rapid Differentiation of Subarachnoid Hemorrhage from Traumatic Lumbar Puncture Using the D-Dimer /Assay

Lang, D.; Berberian, Linda; Ault, Mark J.

doi:10.1093/ajcp/93.3.403

Cited by 30 publications

(23 citation statements)

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“…Other CSF biomarkers tested for SAH diagnosis require further evaluation (for example, urine test stripes for rapid detection of red blood cells in CSF [46]) or have shown inconclusive results (for example, CSF D-dimer [12,47,48]). …”

Section: Other Methodsmentioning

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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Section: Other Methodsmentioning

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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“…Fibrinogen a, p, and y-chains in normal CSF were detected by Wiederkehr et al 1161. Crosslinked fibrinolysis products were found by Lang et al [36] in CSF of patients with subarachnoid hemorrhage, but not in patients with traumatic lumbar puncture. The appearance of fibrin(ogen) degradation products in CSF of patients with psychiatric and neurological disorders as described in this paper might reflect a general increase of fibrinogen in body fluids, but could also be caused by enhanced activity of the fibrinolytic enzymes.…”

Section: Discussionmentioning

confidence: 84%

Analysis of cerebrospinal fluid from patients with psychiatric and neurological disorders by two‐dimensional electrophoresis: Identification of disease‐associated polypeptides as fibrin fragments

et al. 1991

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Two-dimensional electrophoresis (2-DE) of cerebrospinal fluid (CSF) samples--from 347 patients with various psychiatric and neurological disorders--and subsequent silver staining revealed two additional polypeptides (Mr 40,000) in 49% of 111 schizophrenics, 46% of 43 schizoaffective patients, 36% of 41 patients with affective disorders, 43% of 28 patients with multiple sclerosis, but not in 25 patients without neurological symptomatology, nor in 9 patients with Lues, and in only 2 of 25 patients with AIDS. The two polypeptides, as detected by 2-DE, eluted after size exclusion chromatography in fractions containing proteins with Mr greater than 200,000. After 2-DE of CSF samples, enriched by gel chromatography, the polypeptides were immobilized by blotting onto glass-fiber membranes and subjected to N-terminal sequencing. Polypeptide A was identified as beta-chain remnant (beta 2), derived from plasmin cleavage of fibrin(ogen). After size exclusion chromatography, 2-DE, and Western blotting, polypeptide A and B, as well as several other spots, reacted with fibrinogen antibodies, suggesting that the polypeptides are subunits of a fibrin degradation complex.

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“…More recently, other laboratory methods to distinguish traumatic tap from SAH have been proposed. The presence of ferritin and positive D-dimer assay in CSF is more common in SAH than in traumatic tap [23,24] . However, there is no method that distinguishes with certainty a bloody tap from a real hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Can Cerebrospinal Fluid Uric Acid Levels Differentiate Intraventricular Hemorrhage from Traumatic Tap?

Alíefendíoğlu

Gürsoy²,

Hayran³

et al. 2006

Neonatology

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Objective: To measure blood and cerebrospinal fluid (CSF) uric acid (UA) levels of neonates with intraventricular hemorrhage (IVH), and to examine whether or not UA can be used to differentiate traumatic tap from IVH. Material and Methods: The control group (n = 19, group I) consisted of neonates presenting with signs requiring analysis of CSF but whose CSF indices proved to be normal. Traumatic taps (n = 15, group II) were mimicked by adding 2 drops of homologous blood to normal CSF samples. The IVH group (n = 21, group III) consisted of neonates who had been diagnosed by cranial ultrasonography or computed tomography scans. Data are presented as median (range). Results: There was no significant difference between groups with respect to serum UA levels. While no significant difference was observed between CSF UA levels of the control [0.6 (0.1–1.8) mg/dl] and traumatic tap group [0.5 (0.3–1.1) mg/dl], the IVH group [1.6 (0.7–6.9) mg/dl] was found to have significantly higher CSF UA levels than groups I and II. Furthermore, although there were significant correlations between serum and CSF UA levels in the control and traumatic tap groups, no correlation was observed in the IVH group. Conclusion: CSF UA levels are increased in neonates with IVH and they may be used to differentiate a real hemorrhage from a traumatic tap.

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Rapid Differentiation of Subarachnoid Hemorrhage from Traumatic Lumbar Puncture Using the D-Dimer /Assay

Cited by 30 publications

References 0 publications

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

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

Analysis of cerebrospinal fluid from patients with psychiatric and neurological disorders by two‐dimensional electrophoresis: Identification of disease‐associated polypeptides as fibrin fragments

Can Cerebrospinal Fluid Uric Acid Levels Differentiate Intraventricular Hemorrhage from Traumatic Tap?

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