When Ventricular Cerebrospinal Fluid Assessment Misleads: Basal Meningitis and the Importance of Lumbar Puncture Sampling

Khan, Sadid F; Macauley, Thornton; Tong, Steven Y C; Xie, Ouli; Hughes, Carly M.; Hall, Nicholas; Mahanty, Siddhartha; Jennens, Ian; Street, Alan

doi:10.1093/ofid/ofz324

Cited by 11 publications

(8 citation statements)

References 12 publications

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“…It remains controversial whether a protein concentration gradient exists from the ventricular to the lumbar space [49][50][51][52][53]. To rule out variations related to sample origin, CSF samples should originate from the same space [54]. Ten studies compared lumbar CSF from patients with hydrocephalus and control patients [25, 27, 31-33, 35, 37-39, 42], while eight studies compared ventricular CSF from patients with hydrocephalus to lumbar CSF from control patients [21, 23, 26, 28-30, 40, 41].…”

Section: Preanalytical and Analytical Methodsmentioning

confidence: 99%

Inflammatory Markers in Cerebrospinal Fluid from Patients with Hydrocephalus: A Systematic Literature Review

et al. 2021

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Objective. The aim of this systematic review was to evaluate existing literature on inflammatory markers in CSF from patients with hydrocephalus and identify potential markers capable of promoting hydrocephalus development and progression. Methods. Relevant studies published before December 3rd 2020 were identified from PubMed, Embase, and reference lists. Studies were screened for eligibility using the predefined inclusion and exclusion criteria. Data from eligible studies were extracted, and sources of bias were evaluated. We included articles written in English investigating inflammatory markers in CSF from patients with hydrocephalus and control subjects. The review was conducted according to the PRISMA guidelines by three independent reviewers. Results. Twenty-two studies analyzed CSF from 311 patients with idiopathic normal pressure hydrocephalus (iNPH), 178 with posthemorrhagic hydrocephalus (PHH), 151 with other hydrocephalus diagnoses, and 394 control subjects. Fifty-eight inflammatory markers were investigated. The CSF of iNPH patients had increased CSF levels of IL-6, IL-1β, and LRG compared with control subjects, whereas the CSF of PHH patients had increased levels of IL-6, IL-18, and VEGF. CSF from patients with “other hydrocephalus diagnoses” had elevated IFN-γ compared to control subjects, and VEGF was increased in congenital hydrocephalus, spina bifida, and hydrocephalus associated with tuberculous meningitis compared with controls. Conclusion. IL-6, IL-1β, LRG, IL-18, VEGF, and IFN-γ are elevated in CSF from patients with hydrocephalus and may be involved in promotion of hydrocephalus development and progression. They may serve as novel disease biomarkers, and their signaling pathways may represent targets for pharmacological management of hydrocephalus.

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Section: Preanalytical and Analytical Methodsmentioning

confidence: 99%

Inflammatory Markers in Cerebrospinal Fluid from Patients with Hydrocephalus: A Systematic Literature Review

et al. 2021

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“…5,9 Similarly, cell counts are seen to be higher in LP compared to EVD CSF. 10 However, there is limited data on the differences in LP and EVD CSF analysis in monitoring and treatment of meningitis. These differences are important to recognize as it can falsely lead one to believe improvement or worsening of meningitis depending on the site of CSF collection.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Lumbar and Ventricular Cerebrospinal Fluid for Diagnosis and Monitoring of Meningitis

Kakadia

Badger

Zaher

et al. 2021

The Neurohospitalist

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Severe meningitis, especially basilar meningitis, can lead to hydrocephalus requiring external ventricular drain (EVD) placement. There are differences in cerebrospinal fluid (CSF) obtained from an EVD compared to a lumbar puncture (LP). Hence, it becomes difficult to compare LP and EVD samples for diagnosis and monitoring of meningitis. Recognizing these differences is important to properly treat and discontinue antibiotics. We report a case series of 6 patients with meningitis comparing EVD and LP CSF study analysis. In all 6 patients, CSF from LP was obtained before EVD placement by 1.7 days on average. Although corrected white blood cell (WBC) counts were elevated in CSF obtained from LP and EVD, the counts were significantly higher in LP CSF. Protein concentration in LP CSF was also significantly higher than EVD CSF. Glucose and red blood cells varied in both LP and EVD samples. Even though EVD CSF was obtained later in the clinical course than LP, slower circulation of CSF in lumbar space as compared to ventricles is likely the reason for a more sterile appearance of EVD CSF for the diagnosis of meningitis. It is important to recognize these differences as EVD CSF analysis for diagnosis of meningitis may lead to a missed diagnosis and false perception of significant improvement when monitoring response to treatment. One can consider repeating LP prior to discontinuation of antibiotics to properly determine the extent of improvement given EVD CSF sample appears more sterile in comparison. Larger studies are needed to confirm the above findings.

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“…On the other hand, for some pathologies, cases illustrating that there is no statistically significant difference between the CSF composition of malignant cells in these two regions have similarly been reported [ 2 ]. This raises the question of whether the location from which CSF was obtained is of clinical and diagnostic importance [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ventricular and Lumbar Cerebrospinal Fluid Composition

Podkovik¹,

Kashyap²,

Wiginton³

et al. 2020

Cureus

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Cerebrospinal fluid (CSF) analysis is a common diagnostic tool used to evaluate diseases of the central nervous system (CNS). We sought to determine whether there is a difference between the composition of CSF sampled from an external ventricular drain (EVD) and lumbar drain (LD) and whether this made a difference in guiding therapeutic decisions. Patients and Methods This study was a retrospective analysis from a single neurosurgery service between the dates of January 2011 and April 2019. A total of 12,134 patients were screened. Inclusion criteria were ages 18-80 and the presence of both an EVD and LD. Exclusion criteria were not having both routes of CSF sampling and the inability to determine which samples originated from which compartment. Results Six patients underwent simultaneous spinal and ventricular routine CSF sampling <24 hours apart and were analyzed for their compositions. There were 42 samples, but only 20 paired EVD-LD samples that could be analyzed. When comparing the EVD and LD sample compositions, there were statistically significant differences in white blood cells (WBCs; p = 0.040), total protein (p = 0.042), and glucose (p = 0.043). Red blood cells (RBCs; p = 0.104) and polymorphonuclear leukocytes (PMN; p = 0.544) were not statistically significant. We found a statistically significant correlation between cranial and spinal CSF WBC (r = 0.944, p < 0.001), protein (r = 0.679, p = 0.001), and glucose (r = 0.805, p < 0.001). We also found that there was a significant correlation between CSF and serum glucose (r = 0.502, p = 0.040). There was no statistically significant correlation between RBCs (r = 0.276, p = 0.252).

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When Ventricular Cerebrospinal Fluid Assessment Misleads: Basal Meningitis and the Importance of Lumbar Puncture Sampling

Cited by 11 publications

References 12 publications

Inflammatory Markers in Cerebrospinal Fluid from Patients with Hydrocephalus: A Systematic Literature Review

Inflammatory Markers in Cerebrospinal Fluid from Patients with Hydrocephalus: A Systematic Literature Review

Comparison of Lumbar and Ventricular Cerebrospinal Fluid for Diagnosis and Monitoring of Meningitis

Comparison of Ventricular and Lumbar Cerebrospinal Fluid Composition

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