TY - JOUR
T1 - The added value of cerebrospinal fluid analysis in patients with subarachnoid hemorrhage after negative noncontrast CT
AU - van den Berg, René
AU - Jeung, Lung
AU - Post, René
AU - Coert, Bert A.
AU - Hoogmoed, Jantien
AU - Coutinho, Jonathan M.
AU - Majoie, Charles B.
AU - Verbaan, Dagmar
AU - Emmer, Bart J.
AU - Vandertop, William P.
N1 - Funding Information: R.V.D.B. reports a consultancy agreement with CERENOVUS neurovascular (Johnson & Johnson) outside the submitted work (paid to institution). C.B.M. reports receiving grants from TWIN during the conduct of the study and grants from the CVON/Dutch Heart Foundation, European Commission, Dutch Health Evaluation Program, and Stryker outside the submitted work (paid to institution); he is a shareholder of NICO.LAB. Publisher Copyright: © AANS 2022
PY - 2022/4/1
Y1 - 2022/4/1
N2 - OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
AB - OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
KW - aneurysm
KW - cerebrospinal fluid
KW - spinal puncture
KW - subarachnoid hemorrhage
KW - vascular disorders
KW - x-ray computed tomography
UR - http://www.scopus.com/inward/record.url?scp=85127552961&partnerID=8YFLogxK
U2 - https://doi.org/10.3171/2021.4.JNS21656
DO - https://doi.org/10.3171/2021.4.JNS21656
M3 - Article
C2 - 34560662
SN - 0022-3085
VL - 136
SP - 1024
EP - 1028
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 4
ER -