Advertisement

Der Nervenarzt

, Volume 81, Issue 8, pp 973–979 | Cite as

Liquordiagnostik bei CT-negativer Subarachnoidalblutung

  • H. Tumani
  • A. Petzold
  • M. Wick
  • H.-J. Kühn
  • M. Uhr
  • M. Otto
  • A. Regeniter
  • J. Brettschneider
Übersichten

Zusammenfassung

Die Diagnostik CT-negativer Subarachnoidalblutungen (SAB) stellt eine besondere klinische Herausforderung dar. Die Lumbalpunktion mit Liquordiagnostik ist hierbei die diagnostische Methode der Wahl. Die Diagnose einer SAB basiert neben dem visuellen Nachweis eines blutigen bzw. xanthochrom verfärbten Liquors auf der Liquorzytologie mit dem Nachweis von Erythrophagen und Siderophagen. Andere hierzu komplementäre Untersuchungen wie ein Nachweis eines erhöhten Ferritinspiegels oder ein spektrophotometrischer Nachweis einer visuell nicht sichtbaren Xanthochromie sind im Rahmen des klinischen Gesamtbildes sinnvoll. Allgemein ist eine genaue Kenntnis des zeitlichen Ablaufs der Liquorveränderungen nach SAB notwendig, um die Wertigkeit der einzelnen Liquorveränderungen richtig einordnen zu können.

Schlüsselwörter

Subarachnoidalblutung Liquor cerebrospinalis Xanthochromie Zytologie Ferritin Spektrophotometrie 

Cerebrospinal fluid-based diagnostics of CT-negative subarachnoid haemorrhage

Summary

The diagnostic investigation of CT-negative subarachnoid haemorrhage (SAH) is a particular challenge in clinical neurology. Cerebrospinal fluid (CSF) analysis via lumbar puncture is the method of choice. The diagnosis of SAH in CSF is based on a bloody or xanthochromic discoloration of the CSF as well as on findings in non-automated CSF cytology including the detection of erythrophages and siderophages. The automated determination of CSF ferritin concentrations or spectrophotometric detection of xanthochromia may contribute to the diagnosis but are only useful with regard to the overall clinical picture. Generally, the knowledge of the time flow of CSF changes associated with SAH is essential for a correct interpretation of CSF findings.

Keywords

Subarachnoid haemorrhage Cerebrospinal fluid Xanthochromia Cytology Ferritin Spectrophotometry 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    UK NEQAS for Immunochemistry (2003) National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. Ann Clin Biochem 40:481–488CrossRefGoogle Scholar
  2. 2.
    Barrows LJ, Hunter FT, Banker BQ (1955) The nature and clinical significance of pigments in the cerebrospinal fluid. Brain 78:59–80CrossRefPubMedGoogle Scholar
  3. 3.
    Beetham R, Fahie-Wilson MN, Park D (1998) What is the role of CSF spectrophotometry in the diagnosis of subarachnoid haemorrhage? Ann Clin Biochem 35(1):1–4PubMedGoogle Scholar
  4. 4.
    Blennow K, Wallin A, Hager O (1993) Low frequency of post-lumbar puncture headache in demented patients. Acta Neurol Scand 88:221–223CrossRefPubMedGoogle Scholar
  5. 5.
    Falco FA de (2004) Sentinel headache. Neurol Sci 25(Suppl 3):S215–S217CrossRefPubMedGoogle Scholar
  6. 6.
    Rooij NK de, Linn FH, Plas JA van der et al (2007) Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365–1372CrossRefPubMedGoogle Scholar
  7. 7.
    Eskey CJ, Ogilvy CS (2001) Fluoroscopy-guided lumbar puncture: decreased frequency of traumatic tap and implications for the assessment of CT-negative acute subarachnoid hemorrhage. AJNR Am J Neuroradiol 22:571–576PubMedGoogle Scholar
  8. 8.
    Felgenhauer K, Beuche W (1999) Labordiagnostik neurologischer Erkrankungen. Thieme, Stuttgart, S 95–96Google Scholar
  9. 9.
    Fishman R (1992) Composition of the cerebrospinal fluid. In: Cerebrospinal fluid in diseases of the central nervous system. WB Saunders, pp 183–252Google Scholar
  10. 10.
    Lang DT, Berberian LB, Lee S, Ault M (1990) Rapid differentiation of subarachnoid hemorrhage from traumatic lumbar puncture using the D-dimer assay. Am J Clin Pathol 93:403–405PubMedGoogle Scholar
  11. 11.
    Linn FH, Rinkel GJ, Algra A, Gijn J van (1996) Incidence of subarachnoid hemorrhage: role of region, year and rate of computed tomography: a meta-analysis. Stroke 27:625–629PubMedGoogle Scholar
  12. 12.
    Mark DG, Pines JM (2006) The detection of nontraumatic subarachnoid hemorrhage: still a diagnostic challenge. Am J Emerg Med 24:859–863CrossRefPubMedGoogle Scholar
  13. 13.
    Marton KI, Gean AD (1986) The spinal tap: a new look at an old test. Ann Intern Med 104:840–848PubMedGoogle Scholar
  14. 14.
    Mitchell P, Wilkinson ID, Hoggard N et al (2001) Detection of subarachnoid haemorrhage with magnetic resonance imaging. J Neurol Neurosurg Psychiatry 70:205–211CrossRefPubMedGoogle Scholar
  15. 15.
    Morgenstern LB, Luna-Gonzales H, Huber JC Jr et al (1998) Worst headache and subarachnoid hemorrhage: prospective, modern computed tomography and spinal fluid analysis. Ann Emerg Med 32:297–304PubMedGoogle Scholar
  16. 16.
    Neil-Dwyer G, Lang D (1997) Brain attack – aneurysmal subarachnoid haemorrhage: death due to delayed diagnosis. J R Coll Physicians Lond 31:49–52PubMedGoogle Scholar
  17. 17.
    Page KB, Howell SJ, Smith CM et al (1994) Bilirubin, ferritin, D-dimers and erythrophages in the cerebrospinal fluid of patients with suspected subarachnoid haemorrhage but negative computed tomography scans. J Clin Pathol 47:986–989CrossRefPubMedGoogle Scholar
  18. 18.
    Petereit HFSE, Wick M (2007) Leitlinien und Methodenkatalog der Deutschen Gesellschaft für Liquordiagnostik und klinische Neurochemie. Springer Medizin, HeidelbergGoogle Scholar
  19. 19.
    Petzold A, Keir G, Sharpe LT (2004) Spectrophotometry for xanthochromia. N Engl J Med 351:1695–1696CrossRefPubMedGoogle Scholar
  20. 20.
    Petzold A, Keir G, Sharpe TL (2005) Why human color vision cannot reliably detect cerebrospinal fluid xanthochromia. Stroke 36:1295–1297CrossRefPubMedGoogle Scholar
  21. 21.
    Petzold A, Sharpe LT, Keir G (2006) Spectrophotometry for cerebrospinal fluid pigment analysis. Neurocrit Care 4:153–162CrossRefPubMedGoogle Scholar
  22. 22.
    Petzold A, Worthington V, Pritchard C et al (2010) The longitudinal profile of bilirubin and ferritin in the cerebrospinal fluid following a subarachnoid hemorrhage: diagnostic implications. Neurocrit Care (in press)Google Scholar
  23. 23.
    Roost KT, Pimstone NR, Diamond I, Schmid R (1972) The formation of cerebrospinal fluid xanthochromia after subarachnoid hemorrhage. Enzymatic conversion of hemoglobin to bilirubin by the arachnoid and choroid plexus. Neurology 22:973–977PubMedGoogle Scholar
  24. 24.
    Shah KH, Edlow JA (2002) Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage. J Emerg Med 23:67–74CrossRefPubMedGoogle Scholar
  25. 25.
    Sidman RCE, Lemke T (1996) Subarachnoid haemorrhage diagnosis: Lumbar puncture is still needed when the computer tomography scan is normal. Acad Emerg Med 3:827–831CrossRefPubMedGoogle Scholar
  26. 26.
    Sidman R, Spitalnic S, Demelis M et al (2005) Xanthrochromia? By what method? A comparison of visual and spectrophotometric xanthrochromia. Ann Emerg Med 46:51–55CrossRefPubMedGoogle Scholar
  27. 27.
    Stolz E, Oschmann P (2006) Zerebrale Ischämien und Blutungen. In: Wildemann B, Oschmann P, Reiber HG (Hrsg) Neurologische Labordiagnostik. Thieme, Stuttgart, S 189–190Google Scholar
  28. 28.
    Suzuki H, Muramatsu M, Tanaka K et al (2006) Cerebrospinal fluid ferritin in chronic hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurol 253:1170–1176CrossRefPubMedGoogle Scholar
  29. 29.
    Wee N van der, Rinkel GJ, Hasan D, Gijn J van (1995) Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry 58:357–359CrossRefPubMedGoogle Scholar
  30. 30.
    Gijn J van, Kerr RS, Rinkel GJ (2007) Subarachnoid haemorrhage. Lancet 369:306–318CrossRefPubMedGoogle Scholar
  31. 31.
    Walton J (1956) Subarachnoid hemorrhage. E & S Livingstone E, S 118–127Google Scholar
  32. 32.
    Wick M, Fink W, Pfister W et al (1988) Ferritin in cerebrospinal fluid differentiation between central nervous system haemorrhage and traumatic spinal puncture. J Clin Pathol 41:809CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • H. Tumani
    • 1
  • A. Petzold
    • 1
  • M. Wick
    • 1
  • H.-J. Kühn
    • 1
  • M. Uhr
    • 1
  • M. Otto
    • 1
  • A. Regeniter
    • 1
  • J. Brettschneider
    • 1
  1. 1.Abteilung für NeurologyUniversität UlmUlmDeutschland

Personalised recommendations