Abstract
Background: 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).Methods: 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.Results: Among 379 patients (median [IQR:IQR3-IQR1] age 39 [10:43-33] years, 48% female) with acute ischemic stroke (n = 306) or TIA (n = 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.Conclusions: 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.
Highlights
Acute ischemic stroke is the second most frequent cause of death and most frequent cause of acquired adult disability worldwide if all adult age subgroups are considered [1]
Whereas some smaller studies have suggested that CSFanalysis should routinely be performed in young stroke patients [9, 10], the additional diagnostic value of cerebrospinal fluid (CSF)-analysis for the identification of stroke etiology is thought to be low [9]
379 patients aged between 18 and 45 years were admitted to our tertiary care hospital with acute ischemic stroke (n = 306) or transient ischemic attack (TIA) (n = 73)
Summary
Acute ischemic stroke is the second most frequent cause of death and most frequent cause of acquired adult disability worldwide if all adult age subgroups are considered [1]. Whereas some smaller studies have suggested that CSFanalysis should routinely be performed in young stroke patients [9, 10], the additional diagnostic value of CSF-analysis for the identification of stroke etiology is thought to be low [9]. The aim of our study was to analyze the frequency of abnormal CSF-findings and to determine the diagnostic and therapeutic impact of routine CSF-analysis in young adult patients with acute ischemic stroke or transient ischemic attack (TIA). 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)
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