Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Sci Rep. 2023 Dec 15;13(1):22310. doi: 10.1038/s41598-023-49693-y.
Lumbar puncture (LP) is recommended in patients with thunderclap headache and negative computed tomography to rule out spontaneous subarachnoid haemorrhage (SAH). Blood contamination of cerebrospinal fluid (CSF) due to traumatic LP poses a diagnostic dilemma. Therefore, routine CSF parameters were investigated to distinguish between SAH and a traumatic LP. CSF red blood cell (RBC), white blood cell (WBC) count, total protein, CSF colour and supernatant were used for group comparisons of patients with SAH and 'symptomatic controls'. Due to variable time intervals between bleeding onset and LP in SAH patients in contrast to patients with traumatic LP, where blood contamination of CSF occurs at the time of LP, CSF variables were adjusted for decay in time to allow comparability. Logistic regression analysis identified bloody CSF [odds ratio (OR) 32.6], xanthochromic supernatant [OR 15.5] and WBC [OR 4.5 (per increase of 100/µl)] as predictors of SAH, while age, sex and CSF total protein were no predictors. Optimal cut-point of RBC (determined at day 1 after bleeding) was > 3667/µl to identify SAH patients with a 97% sensitivity and 94% specificity. Combination of low RBC and clear CSF supernatant was found in none of SAH patients. Combined CSF RBC count and CSF supernatant reliably distinguished traumatic LP from SAH.
腰椎穿刺（LP）在伴有霹雳性头痛和计算机断层扫描（CT）阴性的患者中被推荐用于排除自发性蛛网膜下腔出血（SAH）。由于 LP 导致的外伤性脑脊液（CSF）血液污染给诊断带来了困境。因此，研究了 CSF 的常规参数以区分 SAH 和外伤性 LP。CSF 红细胞（RBC）、白细胞（WBC）计数、总蛋白、CSF 颜色和上清液用于比较 SAH 患者和“症状对照者”。由于 SAH 患者在出血发作和 LP 之间的时间间隔不同，而外伤性 LP 患者在 LP 时 CSF 就会被血液污染，因此为了使两者具有可比性，对 CSF 变量进行了时间衰减调整。Logistic 回归分析确定血性 CSF[比值比（OR）32.6]、黄变上清液[OR 15.5]和 WBC[OR 4.5（每增加 100/µl）]为 SAH 的预测因素，而年龄、性别和 CSF 总蛋白则不是预测因素。RBC 的最佳截断值（在出血后第 1 天确定）为>3667/µl，以识别具有 97%敏感性和 94%特异性的 SAH 患者。未在任何 SAH 患者中发现低 RBC 和清亮 CSF 上清液的组合。CSF RBC 计数和 CSF 上清液的联合可可靠地区分外伤性 LP 和 SAH。
