Alfayate-Miguélez S, Martínez-Lage-Azorín L, Marín-Vives L, García-Martínez S, Almagro M J, Martínez-Lage J F
Unidad Pediátrica de Enfermedades Infecciosas. Hospital Universitario "Virgen de la Arrixaca", Murcia.
Neurocirugia (Astur). 2011 Apr;22(2):157-61. doi: 10.1016/s1130-1473(11)70014-8.
The standard procedure for the diagnosis of central nervous system (CNS) infections consists of cerebrospinal fluid (CSF) sampling, which is usually accomplished by a lumbar puncture. However, in some patients presenting with acute hydrocephalus submitted to immediate CSF drainage, the fluid is customarily obtained from the placed draining system. In addition, the CSF obtained from the ventricular and lumbar spaces in some cases may show unusual differences, both in physiological and pathological conditions.
We report two children who presented with confounding results in the initial studies of their ventricular and lumbar CSF who were subsequently diagnosed with tuberculous meningitis, causing delay in diagnosis and treatment. AIM. By reporting these cases, we wanted to alert the treating physician about the possibility of this discrepancy to avoid the delayed diagnosis and management of the affected patients.
We comment on the possible pathophysiological mechanisms that may result in this dissociation in ventricular and lumbar CSF composition. CONCLUSIONS; Normal results in CSF studies, especially those of the ventricular fluid, do not always rule out the presence of tuberculous meningitis. We suggest obtaining a CSF sample from the lumbar subarachnoid space in doubtful, or suspicious, cases of CNS infection even in the presence of a normal ventricular CSF.
中枢神经系统（CNS）感染的标准诊断程序包括脑脊液（CSF）采样，通常通过腰椎穿刺完成。然而，对于一些患有急性脑积水并立即进行脑脊液引流的患者，脑脊液通常是从放置的引流系统中获取的。此外，在某些情况下，从脑室和腰椎间隙获取的脑脊液在生理和病理条件下可能会显示出异常差异。
我们报告了两名儿童，他们在最初的脑室和腰椎脑脊液研究中结果令人困惑，随后被诊断为结核性脑膜炎，导致诊断和治疗延迟。目的：通过报告这些病例，我们希望提醒治疗医生注意这种差异的可能性，以避免受影响患者的诊断和治疗延迟。
我们对可能导致脑室和腰椎脑脊液成分出现这种分离的病理生理机制进行了评论。结论：脑脊液检查结果正常，尤其是脑室液检查结果正常，并不总是排除结核性脑膜炎的存在。我们建议，即使脑室脑脊液正常，在中枢神经系统感染存疑或可疑的情况下，也应从腰椎蛛网膜下腔获取脑脊液样本。
