Low Diagnostic Yield of Routine Cerebrospinal Fluid Analysis in Juvenile Stroke

Prakapenia, Alexandra; Barlinn, Kristian; Pallesen, Lars-Peder; Köhler, Anne; Siepmann, Timo; Winzer, Simon; Barlinn, Jessica; Daubner, Dirk; Linn, Jennifer; Reichmann, Heinz; Puetz, Volker

doi:10.3389/fneur.2018.00694

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…Moreover, the CSF-analysis, in this case, presented hyperproteinorraquia and lymphocytic pleocytosis greater than expected for an ischaemic stroke. Previous studies carried out in stroke patients showed a variable range of reactive pleocytosis up to 64 Mpt/L cell and nonspecific proteins up to 1507 mg/L in CSF [7]. In cases describing higher concentrations of cells and proteins, such as our case, pathogens causing vascular damage were found.…”

supporting

confidence: 53%

Unusual simultaneous cerebral infarcts in multiple arterial territories in a COVID-19 patient

Guillán

Villacieros‐Álvarez

Bellido

et al. 2020

Thrombosis Research

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supporting

confidence: 53%

Unusual simultaneous cerebral infarcts in multiple arterial territories in a COVID-19 patient

Guillán

Villacieros‐Álvarez

Bellido

et al. 2020

Thrombosis Research

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“…Pleocytosis in CSF without evidence of infection or vasculitis is frequently found, in our cohort observed in 10% in younger stroke and in 9.3% in older stroke patients. CSF pleocytosis up to 18% after stroke has been reported before, ranging up to 64 cells/µL; in our cohort, one patient had a pleocytosis of 150 cells/µL most likely due to meningeal irritation by hemorrhagic transformation of the ischemic stroke areal.…”

Section: Discussionsupporting

confidence: 54%

“…In a recent study, specific CSF changes were detected in 1.5% of juvenile cerebral ischemia (ischemic strokes and transitoric ischemic attacks (TIA) . Since two out of three patients with infectious etiologies revealed features of infection‐associated vasculitis in MRI, the authors conclude that CSF analysis in juvenile stroke should not be included in routine diagnostics .…”

Section: Discussionmentioning

confidence: 98%

“…In patients with primary angiitis of the central nervous system (PACNS), CSF analysis is usually abnormal due to modest, non‐specific elevations in total protein level or white blood cell count . Recently published, CSF findings such as infectious vasculopathy in juvenile stroke were found in about 1.5% . Still, the necessity of CSF analysis in young stroke is a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

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Intrathecal inflammation in young stroke

et al. 2019

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Stroke is a major cause of disability in the population and the second most common cause of death worldwide. 1 Approximately 10%-14% of stroke patients are younger than 45 years. 2 Stroke etiology in these patients remains unknown in 11% 2 up to 20%. 3 Young stroke patients have a high prevalence of vascular risk factors like hypertension, diabetes mellitus, dyslipidemia, or smoking. 2 Rare causes with potential therapeutic consequences require extensive diagnostic work-up to prevent recurrent stroke. Coagulopathies, genetic, and metabolic diseases as well as autoimmune or infectious vasculopathies have to be considered. 4,5 Acute neuroborreliosis, neurosyphilis, or vasculopathy after bacterial meningitis 6-8 require cerebrospinal fluid (CSF) analysis to obtain the diagnosis. In CSF, elevated cell count, blood-CSF barrier dysfunction, quantitative intrathecal synthesis of immunoglobulin (Ig), as well as the presence of Objectives: Correct identification of inflammatory etiologies of stroke is of outmost importance as they require treatment of the underlying disease. Aim of this study was to determine the prevalence of inflammatory changes in cerebrospinal fluid (CSF) observed in young cryptogenic stroke patients. Materials and Methods:Of 6476 records of patients diagnosed with ischemic stroke, 278 had confirmed ischemia in brain imaging and received lumbar puncture. A total of 122 were classified as young stroke (≤55 years), and 156 were classified as older stroke patients; lumbar puncture in this cohort was indicated due to atypical clinical presentation.Results: An infectious etiology was detected in 2.5% of young stroke patients (n = 3: vasculitis due to opportunistic infection, vasculitis due to neuroborreliosis, secondary vasospasm after viral meningitis) and in 1.9% (n = 3) in the older stroke cohort (vasculitis due to neurotuberculosis, septic embolic ischemia, vasculitis post-haemophilus influenza meningoencephalitis). Isolated vasculitis was evident in one patient of the older stroke cohort (0.6%). Non-specific alterations in CSF included increased cell count in 10% in young and in 9.3% in the older stroke cohort. Intrathecal Ig synthesis was present in 3.4% of the younger and in 4% of the older stroke cohort. Conclusions:The prevalence of an infectious etiology in young stroke is modest but slightly higher in comparison with older stroke patients. As brain imaging is not always sufficient for suspecting vasculitis, we recommend implementation of lumbar puncture in young cryptogenic stroke patients. If an infectious disease is present in ischemic stroke, it is of high therapeutic relevance. K E Y W O R D Scerebrospinal fluid analysis, infection, inflammation, young stroke

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“…In research studies, a broader spectrum of age strata might be useful to study age-dependent differences in mechanisms of acute ischemic stroke. The knowledge deriving from this research might also help design tailored age-related strategies of diagnostic workup in young stroke patients that allow targeted assessment and avoidance of unnecessary procedures ( 48 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Risk Profiles in a Saudi Arabian Cohort of Young Stroke Patients

et al. 2021

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Background: The constantly increasing incidence of stroke in younger individuals substantiates an urgent need for research to elucidate underlying risk factors and etiologies. Heretofore, the vast majority of studies on stroke in the young have been carried out in European and North American regions. We aimed to characterize cerebrovascular risk profiles in a Saudi Arabic cohort of consecutive young stroke patients.Methods: We retrospectively analyzed data from consecutive ischemic stroke patients aged 15 to 49 years who underwent detailed cardiocerebrovascular evaluation at a tertiary stroke care center in Makkah, Saudi Arabia. Distributions of risk factors and stroke etiologies were assessed in the entire cohort and in two strata of very young (15–40 years) and young to middle-aged patients (41–49) to account for variability in suggested age cutoffs.Results: In the entire cohort [n = 63, ages 44 (34–47) median, interquartile range], dyslipidemia (71.4%) and small vessel occlusion (31.7%) displayed highest prevalence followed by diabetes (52.4%) and cardioembolism (19%). In very young patients, cardioembolism was the most prevalent etiology (27.3%). Risk profiles were similar between both age strata except for a higher prevalence of diabetes among the older cohort (31.8 vs. 63.4%, p = 0.01). Logistic regression identified diabetes as strongest predictor for association to the older strata (odds ratio = 4.2, 95% confidence interval = 1.2–14.1, p = 0.02).Conclusion: Cerebrovascular risk profiles and stroke etiologies in our cohort of young stroke patients differ from those of previous cohorts, suggesting the need for tailored prevention strategies that take into account local epidemiological data on cerebrovascular health.

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Low Diagnostic Yield of Routine Cerebrospinal Fluid Analysis in Juvenile Stroke

Cited by 4 publications

References 24 publications

Unusual simultaneous cerebral infarcts in multiple arterial territories in a COVID-19 patient

Unusual simultaneous cerebral infarcts in multiple arterial territories in a COVID-19 patient

Intrathecal inflammation in young stroke

Cerebrovascular Risk Profiles in a Saudi Arabian Cohort of Young Stroke Patients

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