Abstract

Subarachnoid hemorrhage (SAH) is a serious neurological event associated with high morbidity and mortality. Computed tomography of the cerebrum (CTC) is the diagnostic method of choice, but in case of negative CTC but strong suspicion of SAH, lumbar puncture with spectrophotometric analysis of cerebrospinal fluid (CSF) for xanthochromia is performed. We wanted to examine the diagnostic properties of CSF spectrophotometry for xanthochromia testing. We performed a retrospective study of the diagnostic properties of CSF analysis for xanthochromia using spectrophotometry in the diagnosis of SAH. A total of 489 CSF samples were analyzed for xanthochromia, according to international guidelines, from 2009 until 2014 and for 411 of these the patient files were retrieved and examined for final clinical diagnosis and result of CTC. One patient with SAH did not have a positive spectrophotometry report and another patient with SAH had an equivocal report. In four patients did initial CTC not correctly identify SAH. For patients with a negative CTC within six hours of symptom onset spectrophotometry for xanthochromia in the CSF had a diagnostic sensitivity of 100% and a diagnostic specificity of 98.5%. The positive predictive value was 16.7% and the negative predictive value 100%. We conclude that spectrophotometry of CSF for xanthochromia is a sensitive and specific test for diagnosing SAH. However, it seems that an initial CTC identifies almost all patients with SAH. This suggests that in our and similar diagnostic settings, lumbar puncture and testing for xanthochromia might only be relevant in very few cases, if not obsolete.

摘要

蛛网膜下腔出血 (SAH) 是一种严重的神经系统事件，发病率和死亡率都很高。大脑计算机断层扫描 (CTC) 是首选的诊断方法，但在 CTC 阴性但强烈怀疑 SAH 的情况下，进行腰椎穿刺脑脊液 (CSF) 分光光度法分析黄变。我们想检查 CSF 分光光度法对黄变测试的诊断特性。我们对使用分光光度法诊断 SAH 的黄变的 CSF 分析的诊断特性进行了回顾性研究。根据国际指南，从 2009 年到 2014 年，总共对 489 份 CSF 样本进行了黄变分析，其中 411 份患者档案被检索并检查以进行最终临床诊断和 CTC 结果。一名 SAH 患者的分光光度法报告没有阳性，另一名 SAH 患者的报告模棱两可。在 4 名患者中，最初的 CTC 没有正确识别 SAH。对于在症状发作后 6 小时内 CTC 阴性的患者，分光光度法检测 CSF 中的黄变具有 100% 的诊断灵敏度和 98.5% 的诊断特异性。阳性预测值为 16.7%，阴性预测值为 100%。我们得出结论，CSF 黄变的分光光度法是诊断 SAH 的一种灵敏且特异的测试。然而，最初的 CTC 似乎可以识别几乎所有的 SAH 患者。这表明在我们和类似的诊断环境中，腰椎穿刺和黄变检测可能只在极少数情况下相关，如果不是过时的话。