Correlation of CSF opening pressure with clinical and laboratory parameters in patients with acute febrile encephalopathy

Abstract

Background : The lumber puncture and CSF opening pressure in children remains an essential diagnostic test for children with suspected intra cranial pressure in children with meningitis, status epilepticus etc. The LP with accompanying OP is relatively non invasive, easily accessible and rapid procedure with few risks and adverse effects compared with invasive ICP monitoring. CSF opening pressure can give clue to raised intra cranial pressure in these children. There is no normative data available in Indian children. Hence this study was planned to see co relation of abnormally elevated opening pressure with patients clinical, laboratory and radiological parameters and their outcome Methods : Inclusion criteria : Any patient undergoing indicated CSF examination Exclusion criteria : Children with infected skin over the needle entry site, coagulopathy Patients with known CNS lesions (CNS tumour) Denial of consent for lumber puncture Unavailability of CSF manometer Children with proven metabolic encephalopathy (i.e. hepatic encephalopathy, Reyes syndrome) Neonates ( i.e babies Results : Out of 50 patients, only 8 patients ( 16 %) had CSFOP > 28 cm of H2O. maximum number of patients 11 (22%) were diagnosed as having acute bacterial meningitis and acute viral meningoencephalitisout equally . 35 ( 70 %) patients had seizures, out of them only 6 ( 17.14 % ) patients had CSFOP > 28 cms and 29 ( 82.86 %) patients have CSFOP < 28 cms H2O. Out of 9 patients who had status epilepticus, no patient had CSFOP > 28 cms of H2O. maximum number of patients 45 ( 90% ) had GCS < 8 at the time of admission and least number of patients 2 (4%) had GCS of 13-15. Out of those patients who had CSFOP > 28 cms of H2O, maximum number of patients 7 ( 87.5%) had GCS < 8. So out of 8 (100%) patients with CSFOP > 28 cms of H2O, 5 ( 62.5 % ) had bad outcome. on multivariate analysis GCS, CSF results, triage, seizures, radiological features were not significantly associated with bad outcome Conclusion : The threshold of a normal CSF opening should not be interpreted in isolation. Clinical & laboratory parameters does not correlate with CSF opening pressure in every patient. Limitations: Needs large sample size for better understanding.