Prakapenia Alexandra, Barlinn Kristian, Pallesen Lars-Peder, Köhler Anne, Siepmann Timo, Winzer Simon, Barlinn Jessica, Daubner Dirk, Linn Jennifer, Reichmann Heinz, Puetz Volker
Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
Institute of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
Front Neurol. 2018 Aug 22;9:694. doi: 10.3389/fneur.2018.00694. eCollection 2018.
The diagnostic value of cerebrospinal fluid (CSF) analysis in juvenile stroke, i.e., stroke in young adult patients, is not well studied. We sought to determine the therapeutic impact of routine CSF-analysis in young adults with acute ischemic stroke or transient ischemic attack (TIA). We abstracted data from patients with acute cerebral ischemia aged 18-45 years who were consecutively admitted to our stroke center between 01/2008 and 12/2015. We routinely performed CSF-analysis in patients with hitherto unknown stroke etiology after complete diagnostic work up. We assessed the frequency and underlying causes of abnormal CSF-findings and their impact on secondary stroke prevention therapy. Among 379 patients (median [IQR:IQR3-IQR1] age 39 [10:43-33] years, 48% female) with acute ischemic stroke ( = 306) or TIA ( = 73), CSF analysis was performed in 201 patients (53%). Of these, 25 patients (12.4 %) had CSF pleocytosis (leucocyte cell count ≥ 5 Mpt/L), that was rated as non-specific (e.g., traumatic lumbar puncture, reactive pleocytosis) in 22 patients. Only 3 patients (1.5% of all patients who underwent CSF-analysis) with CSF-pleocytosis had specific CSF-findings that were related to stroke etiology and affected secondary stroke prevention therapy. Imaging findings had already suggested cerebral vasculitis in two of these patients. The diagnostic yield of routine CSF-analysis in juvenile stroke was remarkably low in our study. Our data suggest that CSF-analysis should only be performed if further findings raise the suspicion of cerebral vasculitis.
脑脊液（CSF）分析在青少年卒中（即年轻成年患者的卒中）中的诊断价值尚未得到充分研究。我们试图确定常规脑脊液分析对急性缺血性卒中或短暂性脑缺血发作（TIA）的年轻成年人的治疗影响。我们提取了2008年1月至2015年12月期间连续入住我们卒中中心的18 - 45岁急性脑缺血患者的数据。在完成全面诊断检查后，我们对病因不明的卒中患者常规进行脑脊液分析。我们评估了脑脊液异常结果的频率和潜在原因及其对二级卒中预防治疗的影响。在379例急性缺血性卒中（n = 306）或TIA（n = 73）患者中（年龄中位数[四分位间距：四分位间距3 - 四分位间距1]为39[10：43 - 33]岁，48%为女性），201例（53%）患者进行了脑脊液分析。其中，25例（12.4%）患者脑脊液有细胞增多（白细胞计数≥5个/μL），22例被判定为非特异性（如创伤性腰椎穿刺、反应性细胞增多）。脑脊液细胞增多的患者中只有3例（占所有接受脑脊液分析患者的1.5%）有与卒中病因相关的特异性脑脊液结果，并影响了二级卒中预防治疗。其中两名患者的影像学检查结果已提示存在脑血管炎。在我们的研究中，常规脑脊液分析在青少年卒中中的诊断率极低。我们的数据表明，只有在进一步检查结果引发对脑血管炎的怀疑时才应进行脑脊液分析。
