Value Of Cerebrospinal Fluid Analysis Research Articles

Diagnostic value of cerebrospinal fluid analysis in epileptic cats with unremarkable brain MRI or hippocampal signal changes only.

Cerebrospinal fluid (CSF) analysis is used in the diagnostic investigation of cats with epileptic seizures. The aim of this retrospective study was to evaluate the diagnostic value of CSF analysis in cats with epileptic seizures that have unremarkable brain MRI or only hippocampal signal changes. Unremarkable brain MRI or MRI studies with signal alterations in the hippocampus only in cats with suspected epilepsy and CFS analysis performed at the Small Animal Internal Department or Diagnostic Imaging Department at Vetmeduni Vienna, Austria, between 2011 and 2017 were reviewed. Total nucleated cell count, total protein, blood contamination and cytology data from CSF analysis were evaluated. In total, 87 cats were included. Seventy cats (80.5%) had unremarkable MRI, five (5.7%) had hippocampal signal changes with contrast enhancement and 12 (13.8%) had hippocampal signal changes without contrast enhancement. Overall, four cats (4.6%) had abnormalities on CSF analysis; all (100%) had an increased total nucleated cell count (22 cells/μl, 7 cells/μl, 6 cells/μl and 6 cells/μl, respectively), and no cat had increased total protein (100%), although in one cat total protein was not evaluated. Three of these cats had unremarkable MRI and one had hippocampal signal changes without contrast enhancement. The median duration of epileptic signs prior to the MRI study was 2 days. Our results show that, in our cohort of epileptic cats with unremarkable brain MRI or with hippocampal signal changes, CSF analysis was usually normal. This should be considered before performing a CSF tap.

The added value of cerebrospinal fluid analysis in patients with subarachnoid hemorrhage after negative noncontrast CT.

In patients presenting within 6 hours after signs and symptoms of suspected subarachnoid hemorrhage (SAH), CSF examination is judged to be no longer necessary if a noncontrast CT (NCCT) scan rules out SAH. In this study, the authors evaluated the performance of NCCT to rule out SAH in patients with positive CSF findings. Between January 2006 and April 2018, 1657 patients were admitted with a nontraumatic SAH. Of these patients, 1546 had positive SAH findings on the initial NCCT and 111 patients had an NCCT scan that was reported as negative in the acute setting, but with positive CSF examination for subarachnoid blood. Demographic data, World Federation of Neurosurgical Societies grade, and SAH time points (ictus, time of NCCT, and time of lumbar puncture) were collected. All 111 NCCT scans were reevaluated by an experienced neuroradiologist. Of the 111 patients with positive CSF findings, SAH was initially missed on NCCT in 25 patients (23%). Reevaluation of 21 patients presenting within 6 hours of symptom onset confirmed NCCT negative findings in 12 (5 aneurysms), an aneurysmal SAH (aSAH) pattern in 8 (7 aneurysms), and a perimesencephalic pattern in 1 patient. Reevaluation of 90 patients presenting after 6 hours confirmed negative NCCT findings in 74 patients (37 aneurysms), aSAH pattern in 10 (4 aneurysms), and a perimesencephalic pattern in 6 (2 aneurysms). CSF examination is still mandatory to rule out SAH as NCCT can fail to show blood, even within 6 hours after symptom onset. In addition, the diagnosis SAH was frequently missed during initial reporting.

Diagnostic value of cerebrospinal fluid analysis in a population of dogs with suspected idiopathic epilepsy

Cerebrospinal fluid (CSF) analysis is commonly used in the diagnostic investigation of seizure disorders in order to exclude possible inflammatory underlying aetiology. The medical records were searched for dogs presenting...

Does cerebrospinal fluid analysis add predictive value to magnetic resonance imaging for long term irreversible disability in patients with early multiple sclerosis?

BackgroundThe independent prognostic value of cerebrospinal fluid analysis in multiple sclerosis is not established. ObjectiveTo determine the prognostic value of intrathecal synthesis in a cohort of patients with relapsing-onset MS taking into consideration demographic and imaging parameters. MethodsIn this prospective cohort study conducted from 1993 to 2013, we analyzed the time to confirmed disability (persistent above 6months) and irreversible disability (persistent for the entire disease course) of two disability milestones, Expanded Disability Status Scale score ≥4 or 6, and the time to secondary progressive onset in 579 patients with relapsing-onset multiple sclerosis. Demographic parameters (age at onset, gender) and imaging parameters (periventricular lesions) were included in the Cox models. Results447 patients (77.2%) had intrathecal synthesis (oligoclonal bands and/or increased immunoglobulin G index value). No statistically significant relation was found between intrathecal synthesis and the time to reach each disability milestone or secondary progressive onset. An age older than 40years and more than 3 periventricular lesions predicted a worse prognosis. ConclusionsCerebrospinal fluid analysis did not predict the time to disability milestones in relapsing-onset multiple sclerosis independently of age and imaging data.

Diagnostic and prognostic value of cerebrospinal fluid analysis in Vogt‐Koyanagi‐Harada syndrome

AbstractPurpose To evaluate the diagnostic and prognostic values of lumbar puncture in Vogt‐Koyanagi‐Harada (VKH) syndrome.Methods Medical records of patients seen in a single tertiary center between 1995 and 2013, with confirmed VKH syndrome according to the Revised Diagnostic Criterias, were retrospectively reviewed. Clinical stage of the disease, cerebrospinal fluid (CSF) analysis, therapeutic strategy, and prognosis were compared.Results 68 patients with a confirmed diagnosis of VKH disease were initially reviewed. Among them, 29 patients (42%) had undergone a lumbar puncture (LP). 21 LP (72.4%) were performed at the early stage of the disease, and 11 were performed at the chronic stage of the disease (37.6%). 16 patients (55%) had a pleiocytosis. LP was abnormal in 66,7% at the acute phase and 27% at the chronic phase. An average of 62.3 lymphocytes /mm3 was observed when LP was performed during the acute phase and an average of 9.5 lymphocytes / mm3 was observed during the chronic phase ( p = 0,03). For two cases, the patient met the diagnostic criteria because of the LP findings. Patients dependant on low doses of steroids (<5mg/d) had more lymphocytes (93,8 lymphocytesmm3) into the initial CSF analysis compared to the patients dependant on high doses of steroids (>5mg/d) ( 29,3 lymphocytesmm3) (p=0.03) when LP was performed at the acute phase of the disease.Conclusion The number of lymphocytes in the CSF at the diagnostic phase seems to be one of the prognostic factors for the outcome of VKH. Patients with a low pleiocytosis in the initial lumbar puncture should be closely monitored and may require a more aggressive treatment. Those conclusions must be confirmed with a prospective study.

Letter by Yeo et al Regarding Article, “Time-Dependent Test Characteristics of Head CT in Patients Suspected of Nontraumatic Subarachnoid Hemorrhage”

We read with interest the article on diagnosis of subarachnoid hemorrhage (SAH) by early CT scans that proposes to eliminate the need for cerebrospinal fluid absorption spectrophotometry analysis.1 Although we have an almost similar experience with early CT imaging with the modern multislice scanners, the numeric value of 100% for all the accuracy parameters needs to be interpreted carefully, especially in view of the relatively small cohort size of 137 patients. The message that there is no added value of cerebrospinal fluid analysis if CT scan of the head, performed within 6 hours, is normal in patients with acute headache might be applicable only to the advanced tertiary care centers equipped with the best scanners and best interpreters. Considering that …

Response to Letter Regarding Article, “Time-Dependent Test Characteristics of Head CT in Patients Suspected of Nontraumatic Subarachnoid Hemorrhage”

We thank Dr Yeo and coworkers for their interest in our study, in which we concluded that in patients presenting with acute headache and a normal head CT ≤6 hours after ictus, there is no added value of cerebrospinal fluid analysis.1 Dr Yeo and coworkers warn that our results need to be interpreted with caution. We cannot agree more, and that is why we emphasized (as Yeo et al do) that our results only can be extrapolated to high-volume tertiary care centers where head CT scans are interpreted by experienced neuroradiologists.1 However, Yeo et al end with the recommendation that in patients with acute headache but a negative early CT scan, a lumbar puncture should still be performed and perhaps even combined with a CT angiography. They illustrate their …

Prognostic value of cerebrospinal fluid analysis at the time of a first demyelinating event

Background and Objective: This study aimed to assess the value of cerebrospinal fluid (CSF) findings for predicting conversion to clinically definite multiple sclerosis (CDMS). Methods: From a database of 447 patients with a first demyelinating event, the records of 208 patients less than 51 years old who had baseline magnetic resonance imaging (MRI) and CSF examinations and a follow-up of at least 1 year were included. A multivariable Cox model was used to assess the short-term risk of CDMS according to baseline CSF findings after adjustment for prognostic factors (including brain MRI) and to provide a simple classification for predicting CDMS. Results: During a median follow-up of 3.5 years, 141 (67.8%) patients converted to CDMS. In multivariate analysis, younger age (hazard ratio [HR]: 1.44 [95% CI 1.02–2.01]), spatial dissemination on brain MRI (HR: 2.07 [95% CI 1.47–2.91]) and more than 4 WBC/mm3 in CSF (HR: 1.44 [95% CI 1.03–2.02]) were independently associated with CDMS. The Cox score obtained from these three predictors enabled patients to be divided into three groups with significant increased risks of CDMS at 1, 2 and 3 years; groups were classified as high-risk (64.7%, 77.4%, 96.1%), intermediate-risk (33.3%, 51.5%, 61.5%), and low-risk (11.1%, 18.3%, 40.3%). Conclusions: Age at onset, spatial dissemination on brain MRI and CSF white blood cell count are independently associated with short-term conversion to CDMS. The three proposed risk group classifications could be a useful tool to select patients for early therapeutic intervention.

Difficulties in the differentiation of chronic inflammatory diseases of the central nervous system - value of cerebrospinal fluid analysis and immunological abnormalities in the diagnosis

A number of neurological syndromes may be evoked by involvement of the nervous system due to systemic diseases such as lupus erythematodes, sarcoidosis, Behçet's disease and Sjögren's syndrome (SS) and may be confounded with another chronic inflammatory disease which is restricted to the central nervous system, e.g. multiple sclerosis (MS). Because of different treatment strategies, it is important to distinguish between these different autoimmune diseases. Neither clinical signs nor additional analyses such as serological findings or cerebrospinal fluid (CSF) analysis are able to differentiate between the diseases with certainty. Nevertheless, taking all findings together, diagnosis may be possible. Here we compare typical clinical and CSF findings in MS, neurosarcoidosis, neurolupus, neuro-Behçet and nervous system involving SS with special emphasis on those findings allowing differentiation of the respective diseases by reviewing the literature.

Complement C3 and factor B cerebrospinal fluid concentrations in bacterial and aseptic meningitis

Establishing a diagnosis is difficult in most cases of acute meningitis, since its clinical signs are non-specific, and laboratory examination of cerebrospinal fluid (CSF) often does not accurately differentiate between bacterial and aseptic meningitis. 1 Lindquist L Linné T Hansson L-O Kalin M Axelsson G Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection. Eur J Clin Micmbiol Infect Dis. 1988; 7: 374-380 Crossref PubMed Scopus (90) Google Scholar , 2 Rodewald LE Woodin KA Szilagyi PG Arvan DA Raubertas RF Powell KR Relevance of common tests of cerebrospinal fluid in screening for bacterial meningitis. J Pediatr. 1991; 119: 363-369 Summary Full Text PDF PubMed Scopus (27) Google Scholar Therefore the identification of a discriminating parameter, which might lead to a rapid and accurate clinical test, would be of value in the differential diagnosis of acute meningitis.

Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: A study in 710 patients with suspected central nervous system infection

A prospective study to determine the value of cerebrospinal fluid analysis in the differential diagnosis of meningitis was performed in 710 consecutively observed patients, both children and adults, who underwent lumbar puncture due to suspected central nervous system infection. Diagnoses included acute or presumed bacterial meningitis (n = 79), acute or presumed viral meningoencephalitis (n = 218), acute unclassified meningitis (n = 6), other infections of the central nervous system (n = 37), non-infectious neurological diseases (n = 76) and control patients (n = 294). The sensitivity, specificity and predictive values were determined for cerebrospinal fluid white blood cell count, total protein, lactate, glucose and C-reactive protein levels as well as the blood/cerebrospinal fluid glucose ratio. Determination of cerebrospinal fluid levels of lactate (greater than or equal to 3.5 mmol/l) was found to be superior to the other tests. The C-reactive protein level gave no additional diagnostic information when the lactate level was determined. The white blood cell count, and total protein and glucose levels were often unreliable tools for differential diagnosis, largely due to low sensitivity at realistic discriminatory limits. The study confirms that no cerebrospinal fluid test is fully reliable in distinguishing bacterial meningitis from other forms of meningitis.