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The added value of cerebrospinal fluid analysis in patients with subarachnoid hemorrhage after negative noncontrast CT. / van den Berg, René; Jeung, Lung; Post, René et al.

In: Journal of neurosurgery, Vol. 136, No. 4, 01.04.2022, p. 1024-1028.

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@article{fdbbe77896894f7796832c880cc9b7c1,
title = "The added value of cerebrospinal fluid analysis in patients with subarachnoid hemorrhage after negative noncontrast CT",
abstract = "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.",
keywords = "aneurysm, cerebrospinal fluid, spinal puncture, subarachnoid hemorrhage, vascular disorders, x-ray computed tomography",
author = "{van den Berg}, Ren{\'e} and Lung Jeung and Ren{\'e} Post and Coert, {Bert A.} and Jantien Hoogmoed and Coutinho, {Jonathan M.} and Majoie, {Charles B.} and Dagmar Verbaan and Emmer, {Bart J.} and Vandertop, {William P.}",
note = "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: {\textcopyright} AANS 2022",
year = "2022",
month = apr,
day = "1",
doi = "10.3171/2021.4.JNS21656",
language = "English",
volume = "136",
pages = "1024--1028",
journal = "Journal of neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

RIS

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 - 10.3171/2021.4.JNS21656

DO - 10.3171/2021.4.JNS21656

M3 - Article

C2 - 34560662

VL - 136

SP - 1024

EP - 1028

JO - Journal of neurosurgery

JF - Journal of neurosurgery

SN - 0022-3085

IS - 4

ER -

ID: 20842448