Traumatic Tap Research Articles

Determination of leukocytosis in traumatic spinal tap specimens: Mayefsky JH, Roghmann KJ. Am J Med 1987; 82:1175–1181

Determination of leukocytosis in traumatic spinal tap specimens: Mayefsky JH, Roghmann KJ. Am J Med 1987; 82:1175–1181

Nontraumatic Lumbar Puncture

A technique and formula for avoiding the traumatic spinal tap is reported from the Medical College of Wisconsin, Milwaukee, WI.

Cerebral Vasculitis Associated With Cocaine Abuse or Subarachnoid Hemorrhage?-Reply

In Reply. —We would like to thank Drs Levine, Welch, and Brust for raising the interesting possibility of subarachnoid hemorrhage as the etiology for the neurological events that occurred in our patient. Certainly, subarachnoid hemorrhage, arteriovenous malformations, cerebral ischemia, and cerebral vasculitis can all present with similar clinical manifestations. It is unfortunate that the cerebrospinal fluid obtained from our patient was not examined for xanthochromia because it makes it difficult to know whether the blood in the cerebrospinal fluid was the result of a traumatic spinal tap. We also should note that the left-sided cerebral circulation, as mentioned in our article, was normal. The distal vessels of the right-sided cerebral circulation did not fill with dye. Although the cerebral angiographic findings in our patient could be the result of vasospasm following a subarachnoid hemorrhage, there are several radiographic features that make this diagnosis less likely. First of all, in patients

Determination of leukacytosis in traumatic spinal tap specimens

Determination of leukacytosis in traumatic spinal tap specimens

Determination of leukocytosis in traumatic spinal tap specimens

White and red blood cell counts from peripheral blood and from the cerebrospinal fluid of all patients who had traumatic lumbar punctures over a five-year period were studied to determine the diagnostic value of using the ratio of white blood cell to red blood cells in peripheral blood to adjust the white blood cell count found in the bloody cerebrospinal fluid. In patients without meningitis, 55 percent of the cerebrospinal fluid specimens had more white blood cells than could be attributed to trauma. However, in only 10 percent was the actual white blood cell count more than 10 times greater than the number referable to trauma. In 38 percent, there were fewer white blood cells in the cerebrospinal fluid than the ratio predicted. Such underestimation was uncommon among patients with culture-positive meningitis: the ratio failed to detect leukocytosis in only 10 percent, and all but one of these patients had clinical reasons for the low cerebrospinal fluid count. It is concluded that true leukocytosis is rarely masked in blood-contaminated cerebrospinal fluid, and that the presence of more than 10 times the number of white blood cells than allowed by the adjustment is a sensitive and specific indicator of meningitis. However, a simple mechanical use of the formula is not justified, and all available clinical and laboratory data should be used when deciding whether to institute treatment in a patient with possible meningitis and bloody spinal fluid.

What represents pleocytosis in blood-contaminated (“traumatic tap”) cerebrospinal fluid in children?

THE NUMBER of white blood cells normally present in cerebrospinal fluid after a nontraumatic lumbar puncture has been clearly established? ~2 Although the number of WBCs in CSF contaminated with blood has not been studied systematically, suggested definitions for normal values include a comparable WBC/RBC ratio in CSF and in peripheral blood ~ or the use of an arbitrary WBC/RBC ratio of 1:300. 4 Both of these definitions imply that when CSF is contaminated with blood there exists a fixed relationship between the number of RBCs and WBCs in CSF and peripheral blood, in the absence of preexisting CSF pleocytosis. Two recent analyses of blood-stained CSF specimens obtained from a small number of patients without meningitis demonstrated fewer WBCs than expected from calculation of the peripheral blood WBC/RBC ratio. ~,6 This observation suggests that current definitions might well obscure the detection of true CSF pleocytosis in such specimens, The purpose of our study was to analyze a larger number of blood-contaminated CSF samples in order to define better the relationship between the number of WBCs present and the expected number calculated from peripheral blood RBC and WBC counts. METHODS We performed a retrospective analysis of the CSF data of all patients at The Children's Memorial Hospital during 1983 whose CSF samples contained > 1000 RBC/mm 3 and in whom a complete blood count was performed simultaneously with or within 2 hours of lumbar puncture. CSF cell counts were done routinely using the standard counting chamber and acetic acid lysis technique described by Hepler. 7 CSF samples obtained by a neurosurgical procedure or with positive bacteriologic culture not judged to be a contaminant were excluded. Because it had been suggest

What represents pleocytosis in blood-contaminated (“traumatic tap”) cerebrospinal fluid in children : Rubenstien JS, Yogev R. J Pediatr 1985; 107:249–251

What represents pleocytosis in blood-contaminated (“traumatic tap”) cerebrospinal fluid in children : Rubenstien JS, Yogev R. J Pediatr 1985; 107:249–251

Lysis of erythrocytes and leukocytes in traumatic lumbar punctures.

We created "bloody taps" by adding homologous blood to acellular samples of CSF and counted the RBCs and WBCs at specific time intervals. After two hours at room temperature (22 degrees C), 40% of the WBCs in the traumatic tap had lysed. At 4 degrees C, 15% of the cells lysed in the same period of time. After five hours at 22 degrees C, 53% of the WBCs had lysed, while refrigeration reduced this figure to 31%. The clinical implications of these data are clear. If a sample of CSF is not promptly refrigerated and analyzed, WBC lysis will result in a false impression of the number of WBCs that are present. This lysis of WBCs reduces the reliability of the corrective formula that uses CSF and blood RBC and WBC counts to estimate the number of WBCs in CSF that are attributable to contamination with blood.

Cerebral Intraventricular Hemorrhages in Infants: A Widening Age Spectrum

Cerebral intraventricular hemorrhage (IVH), a problem widely recognized in premature infants, was found in six older infants, ages 2 weeks to 3 months. IVH was often initially misdiagnosed as subarachnoid hemorrhage or meningits with a traumatic lumbar tap. IVH occurred primarily in infants with hypoxemia, acidosis, ischemia, and/or hypernatremia, conditions found in association with IVH in premature infants, but also occurred spontaneously. Computerized tomography scans were the most valuable diagnostic procedure for detection of IVH.

Differentiation of early subarachnoid hemorrhage from traumatic lumbar puncture.

The problem of early differentiation of "traumatic tap" from subarachnoid hemorrhage (SAH) was studied in the rabbit by determining the changes in percentage of hemolysis and in lactate concentrations in CSF within the first twenty-four hours following induced SAH. The 0.3 to 7% hemolysis which occurred was relatively independent both of the time following SAH and of the number of red blood cells (rbc) in the cerebrospinal fluid (CSF). There was, on the other hand, a significant and time-dependent increase in CSF lactate concentration early after SAH, suggesting the potential clinical value of the detection of increased lactate with a relatively normal lactate/pyruvate ratio in hemorrhagic CSF. Until this can be evaluated in human subjects, however, determination of the rbc counts or total hemoglobin concentrations in serially collected samples of CSF remains the best clinical method.