Martin Sean C G, Teo Mario K C H, Young Adam M H, Godber Ian M, Mandalia Sachin S, St George Edward J, McGregor Calum
a Department of Acute Medicine , Wishaw General Hospital , Wishaw , UK.
b Department of Neurosurgery , Institute of Neurological Science , Glasgow , UK.
Br J Neurosurg. 2015;29(6):799-803. doi: 10.3109/02688697.2015.1084998. Epub 2015 Sep 16.
Acute severe headache is a common medical presentation, and a common area of diagnostic uncertainty. Subarachnoid haemorrhage (SAH) is the cause in a minority of patients and has a high rate of morbidity and mortality. Therefore, its conclusive diagnosis with computed tomography (CT) or lumbar puncture (LP) is paramount. With advancement in imaging technology, emerging evidence now suggests that LP is no longer required for a subset of patients as CT has 100% sensitivity in detecting SAH, when performed under specific conditions.
To assess the proportion of patients with conclusive CSF xanthochromia results following a negative CT scan in suspected SAH to determine the diagnostic efficacy of LP.
CSF bilirubin and oxyhaemoglobin spectrophotometric absorbance data from all centres in a regional health board were identified for consecutive patients over a 6-month period. Results were stratified as conclusive (positive or negative), or inconclusive according to national guidelines.
239 of 255 (93.7%) results were conclusive: 89.0% were negative (227 of 255). 4.7% of results were positive (12 of 255), revealing 4 cerebral aneurysms requiring treatment. 16 out of 255 (6.3%) samples were inconclusive, yielding 1 aneurysm requiring treatment. In the same period, there were 27 CT-positive cases of SAH.
LP has a high diagnostic yield, eliminating the need for neurosurgical opinion or investigation in almost 90% of cases. The test is both cost and time efficient and subjects only a small number of patients to the radiation and contrast risks of angiography.
急性重度头痛是一种常见的医学症状，也是诊断存在不确定性的常见领域。蛛网膜下腔出血（SAH）是少数患者的病因，且发病率和死亡率很高。因此，通过计算机断层扫描（CT）或腰椎穿刺（LP）进行确诊至关重要。随着成像技术的进步，新出现的证据表明，对于一部分患者而言，由于在特定条件下进行CT检查对SAH的检测灵敏度达100%，因此不再需要进行LP检查。
评估疑似SAH患者CT扫描结果为阴性后，脑脊液黄变症确诊结果的患者比例，以确定LP的诊断效能。
确定某地区卫生委员会所有中心连续6个月内患者的脑脊液胆红素和氧合血红蛋白分光光度吸收数据。根据国家指南，将结果分为确诊（阳性或阴性）或不确定。
255份结果中有239份（93.7%）为确诊：89.0%为阴性（255份中的227份）。4.7%的结果为阳性（255份中的12份），发现4例需要治疗的脑动脉瘤。255份样本中有16份（6.3%）不确定，发现1例需要治疗的动脉瘤。同期，有27例SAH的CT阳性病例。
LP具有很高的诊断率，在近90%的病例中无需神经外科会诊或进一步检查。该检查具有成本效益和时间效益，仅使少数患者面临血管造影的辐射和造影剂风险。
