National audit of cerebrospinal fluid testing

Holbrook, Ian; Beetham, Robert; Cruickshank, Anne; Egner, William; Fahie-Wilson, Michael N.; Keir, Geoff; Patel, Dina; Watson, Ian D.; White, Peter

doi:10.1258/000456307781646085

Cited by 18 publications

(19 citation statements)

References 2 publications

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“…It is therefore remarkable that little consensus exists amongst different laboratories about the reference ranges for CSF glucose and lactate [1]. CSF glucose is decreased in, amongst others, patients with bacterial meningitis and leptomeningeal carcinomatosis, usually in combination with other abnormal CSF parameters, such as an elevated leucocyte count, total protein or lactate concentration [2]–[4].…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

et al. 2012

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Cerebrospinal fluid (CSF) analysis is an important tool in the diagnostic work-up of many neurological disorders, but reference ranges for CSF glucose, CSF/plasma glucose ratio and CSF lactate based on studies with large numbers of CSF samples are not available. Our aim was to define age-specific reference values. In 1993 The Nijmegen Observational CSF Study was started. Results of all CSF samples that were analyzed between 1993 and 2008 at our laboratory were systematically collected and stored in our computerized database. After exclusion of CSF samples with an unknown or elevated erythrocyte count, an elevated leucocyte count, elevated concentrations of bilirubin, free hemoglobin, or total protein 9,036 CSF samples were further studied for CSF glucose (n = 8,871), CSF/plasma glucose ratio (n = 4,516) and CSF lactate values (n = 7,614). CSF glucose, CSF/plasma glucose ratio and CSF lactate were age-, but not sex dependent. Age-specific reference ranges were defined as 5–95th percentile ranges. CSF glucose 5th percentile values ranged from 1.8 to 2.9 mmol/L and 95th percentile values from 3.8 to 5.6 mmol/L. CSF/plasma glucose ratio 5th percentile values ranged from 0.41 to 0.53 and 95th percentile values from 0.82 to 1.19. CSF lactate 5th percentile values ranged from 0.88 to 1.41 mmol/L and 95th percentile values from 2.00 to 2.71 mmol/L. Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age. These reference values allow a reliable interpretation of CSF results in everyday clinical practice. Furthermore, hypoglycemia was associated with an increased CSF/plasma glucose ratio, whereas hyperglycemia did not affect the CSF/plasma glucose ratio.

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Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

et al. 2012

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“…After surgical hemostasis, intrathecal pressure recovered, but lactate concentration into cerebrospinal fluid, even lowered, remained above normal values [5].…”

Section: Discussionmentioning

confidence: 93%

“…During the operation we monitored intratecal pressure (P csf ) and the spinal cord perfusion pressure (PP csf ) along with Lactate concentration into CSF (Lac csf ) because it may be a marker of local ischemic suffering [5][6][7][8]. Lac csf and P csf did not showed significant alterations, intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair

Corazzi¹,

Stefania²,

Giustiniano³

et al. 2018

Int J Anesthetic Anesthesiol

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Paraplegia is one of the most devastating complication after Thoraco-abdominal Aorta (TAA) repair both in open surgery and in endovascular procedure, caused by critical obstruction to blood perfusion of the Spinal Cord.Spinal Cord Ischemia (SCI) may be due to hemodynamic impairment and/or to segmental artery occlusion during aortic clamping [1,2].We report a case of chronically dissected Thoraco-abdominal Aortic Aneurysm (TAAA) which showed unilateral transient neurological impairment of the left lower limb, postoperatively. KeywordsSpinal cord injury, Aorta, Surgery chronic obstructive pulmonary disease (COPD) with FEV1/FVC ratio 0.43 and FEV1 1.12 L (44%).The pre-operative echocardiogram showed: Mild hypertrophy of left ventricle walls (13-14 mm), left ventricle end-diastolic volume at upper limit (LVEDVi = 74 ml/ m 2 ), inferior wall and interventricular septum were akinetic providing a reduced ejection fraction (LVEF 0.38) that did ameliorate at dobutamine echo-stress (LVEF 0.47); furthermore it showed mild aortic valve stenosis (medium pressure gradient 20 mmHg with valve area 1.2 cm 2 ).He underwent general anesthesia that was inducted by Midazolam 5 mg iv, Fentanyl 200 mcg iv. After myorelaxation with cis-Atracurium 12 mg iv a double-lumen endotracheal tube n.41 was inserted to connect the patient's airways to mechanical ventilator (Vt 560; respiratory rate 12; positive end-expiratory pressure 5 cm H 2 O); he received a gas mixture of oxygen/air (FiO 2 40-60%) and Sevoflurane 1-2%, as appropriate. Myorelaxation continued with cis-Atracurium 1 mg/kg/h. Remifentanil 0.1-0.2 mcg/kg/min was administered.

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“…4 It was the aim of these guidelines to harmonise the clinical laboratory approach to analysis and interpretation of CSF spectrophotometry to evidencebased best practice standards. Following a national audit 5 and iterative consultation, 6 a revised version of this guideline was published in 2008. 2 One of the aims of the revised guidelines was to emphasise the clinical significance of increased CSF bilirubin with a visible oxyhaemoglobin absorbance peak irrespective of the CSF total protein concentration.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid total protein cannot reliably distinguish true subarachnoid haemorrhage from other causes of raised cerebrospinal fluid net bilirubin and net oxyhaemoglobin absorbances

et al. 2014

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Background: In cerebrospinal fluid (CSF) spectrophotometry, if the net bilirubin absorbance (NBA) and net oxyhaemoglobin absorbance (NOA) are both raised with a visible oxyhaemoglobin peak, the revised national guidelines for analysis of CSF bilirubin advise interpreting the results as 'Consistent with subarachnoid haemorrhage (SAH)' regardless of the CSF total protein concentration of the specimen. We wanted to study the range of CSF total protein concentrations found in confirmed SAH to establish if the CSF total protein value can give further guidance on the likelihood of SAH. Methods: Consecutive cases from five different hospital sites were included if the CSF NBA was greater than 0.007 AU and the NOA was greater than 0.02 AU with a visible oxyhaemoglobin peak. For the cases identified, the laboratory information management system and patient records were interrogated to identify the total protein concentration of the CSF specimen and whether SAH had ultimately been confirmed or excluded by other methods and supporting evidence. Results: Results from 132 patients were included. The CSF total protein range in confirmed SAH was 0.23-3.08 g/L with a median concentration of 0.7 g/L (n ¼ 51). In the SAH excluded group, the CSF total protein range was 0.43-29 g/L with a median concentration of 1.9 g/L (n ¼ 81). Conclusions: Although confirmed SAH was not associated with the very highest concentrations of CSF total protein, a definite CSF protein cut-off concentration above which SAH could reliably be excluded cannot be recommended.

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National audit of cerebrospinal fluid testing

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Cited by 18 publications

References 2 publications

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair

Cerebrospinal fluid total protein cannot reliably distinguish true subarachnoid haemorrhage from other causes of raised cerebrospinal fluid net bilirubin and net oxyhaemoglobin absorbances

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