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Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?

Nagy, Karin ; Skagervik, Ina ; Tumani, Hayrettin ; Petzold, Axel ; Wick, Manfred ; Kühn, Hans-Jürgen ; Uhr, Manfred ; Regeniter, Axel ; Brettschneider, Johannes ; Otto, Markus ; Kraus, Jörg ; Deisenhammer, Florian ; Lautner, Ronald ; Blennow, Kaj ; Shaw, Leslie ; Zetterberg, Henrik ; Mattsson, Niklas

In: Clinical Chemistry and Laboratory Medicine, 2013, vol. 51, no. 11, p. 2073-2086

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    Title
    • Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?
    Author
    • Nagy, Karin. Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital/Mölndal, S-431 80 Mölndal, Sweden
    • Skagervik, Ina. Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
    • Tumani, Hayrettin. Department of Neurology, University of Ulm, Ulm, Germany
    • Petzold, Axel. University College London Institute of Neurology, Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, London, UK; Department of Neurology and VU University Medical Center, Department of Neurology, Amsterdam, The Netherlands
    • Wick, Manfred. Department of Clinical Chemistry, Ludwig Maximilian University, Munich, Germany
    • Kühn, Hans-Jürgen. Department of Clinical Chemistry, University of Leipzig, Leipzig, Germany
    • Uhr, Manfred. Max Planck Institute for Psychiatry, Munich, Germany
    • Regeniter, Axel. Department of Clinical Chemistry, University Hospital Basel, Basel, Switzerland
    • Brettschneider, Johannes. Department of Neurology, University of Ulm, Ulm, Germany
    • Otto, Markus. Department of Neurology, University of Ulm, Ulm, Germany
    • Kraus, Jörg. Department of Neurology, Paracelsus Medical University, Salzburger Landesklinik, Salzburg, Austria
    • Deisenhammer, Florian. Department of Neurology, University of Innsbruck, Innsbruck, Austria
    • Lautner, Ronald. Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg/Mölndal, Sweden
    • Blennow, Kaj. Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg/Mölndal, Sweden
    • Shaw, Leslie. Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
    • Zetterberg, Henrik. Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg/Mölndal, Sweden
    • Mattsson, Niklas. Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg/Mölndal, Sweden
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Clinical Chemistry and Laboratory Medicine, 2013, vol. 51, no. 11, p. 2073-2086. De Gruyter
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:297067
    Summary
    Subarachnoid haemorrhage (SAH) has a high mortality and morbidity rate. Early SAH diagnosis allows the early treatment of a ruptured cerebral aneurysm, which improves the prognosis. Diagnostic cerebrospinal fluid (CSF) analyses may be performed after a negative computed tomography scan, but the precise analytical methods to be used have been debated. Here, we summarize the scientific evidence for different CSF methods for SAH diagnosis and describe their implementation in different countries. The principle literature search was conducted using PubMed and Scopus with the search items "cerebrospinal fluid”, "subarachnoid haemorrhage”, and "diagnosis”. CSF analyses for SAH include visual examination, red blood cell counts, spectrophotometry for oxyhaemoglobin or bilirubin determination, CSF cytology, and ferritin measurement. The methods vary in availability and performance. There is a consensus that spectrophotometry has the highest diagnostic performance, but both oxyhaemoglobin and bilirubin determinations are susceptible to important confounding factors. Visual inspection of CSF for xanthochromia is still frequently used for diagnosis of SAH, but it is advised against because spectrophotometry has a superior diagnostic accuracy. A positive finding of CSF bilirubin is a strong indicator of an intracranial bleeding, whereas a positive finding of CSF oxyhaemoglobin may indicate an intracranial bleeding or a traumatic tap. Where spectrophotometry is not available, the combination of CSF cytology for erythrophages or siderophages and ferritin is a promising alternative