Does urgent cerebrospinal fluid (CSF) analysis After-Hours alter patient management?

Background Children’s hospitals often do not have a high enough volume to justify providing radiologist staffing overnight, leading to hospitals employing teleradiology services to offer preliminary reports. There is limited literature related to discrepancies between preliminary teleradiology pediatric radiologists and final interpretations. Purpose The purpose of this study is to examine discrepancy rates for teleradiologists preliminarily interpreting pediatric exams at a children’s hospital. Material and Methods Eight thousand seven hundred seventy-eight consecutive preliminary reports issued by pediatric teleradiologists were reviewed. The hospital utilized a system in which local onsite radiologists rated the preliminary reports of teleradiologists following the interpretations as part of standard operating procedure. Discrepancies were also rated according to whether the discrepancy was actionable (judged to alter patient management by the final rater) or not. Rates were stratified by modality, preliminary teleradiologist reader, and final rater and compared to each using a normal approximation. The mean discrepancy rates were compared using a z test for proportions. Linear regression was applied to the effect of years of radiologist experience on the total and actionable discrepancy rates. Results The overall actionable discrepancy rate was 1.6%, similar to inter-observer discrepancy rates reported in other studies. There were no significant differences in the actionable discrepancy rates among teleradiologists. There was no correlation between years of experience and discrepancy rate for either the teleradiologists or the final raters. Conclusion Pediatric subspecialty teleradiologists issue reports that mirror discrepancy rates typical of radiologists who issue reports for emergent adult studies. Years of radiologist experience is not a predictor of discrepancy rate.

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Extremely Elevated Cerebrospinal Fluid Protein and Glucose Level in a Neonate with Hypernatremic Dehydration

Journal of Pediatric Neurology ◽

10.1055/s-0040-1708496 ◽

2020 ◽

Author(s):

Arti Maria ◽

Tapas Bandyopadhyay

Keyword(s):

Cerebrospinal Fluid ◽

Neurodevelopmental Outcome ◽

Neurological Sequelae ◽

Glucose Levels ◽

Csf Analysis ◽

First Case ◽

Time Of Admission ◽

Cerebrospinal Fluid Protein ◽

Hypernatremic Dehydration

AbstractWe describe the case of a term newborn who presented with hypernatremic dehydration on day 19 of life. The baby was otherwise hemodynamically stable with no evidence of focal or asymmetric neurological signs. The laboratory tests at the time of admission were negative except for hypernatremia and the extremely elevated levels of cerebrospinal fluid (CSF) protein (717 mg/dL) and glucose levels (97 mg/dL). The hypernatremic dehydration was corrected as per the unit protocol over 48 hours. Repeat CSF analysis done after 5 days showed normalization of the protein and glucose levels. Serial follow-up and neuroimaging showed no evidence of neurological sequelae. Unique feature of our case is this is the first case reporting such an extreme elevation of CSF protein and glucose levels that have had no bearing on neurodevelopmental outcome at 1 month and 3 months of follow-up.

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Drainage of cerebral interstitial fluid into deep cervical lymph of the rabbit

AJP Renal Physiology ◽

10.1152/ajprenal.1981.240.4.f329 ◽

1981 ◽

Vol 240 (4) ◽

pp. F329-F336 ◽

Cited By ~ 31

Author(s):

M. W. Bradbury ◽

H. F. Cserr ◽

R. J. Westrop

Keyword(s):

Cerebrospinal Fluid ◽

Caudate Nucleus ◽

Subarachnoid Space ◽

Interstitial Fluid ◽

Bulk Flow ◽

Perivascular Spaces ◽

Csf Analysis ◽

Intraventricular Injections ◽

Intracerebral Microinjection ◽

Do So

Lymph from the jugular lymph trunks of anesthetized rabbits has been continuously collected and radioiodinated albumin (RISA) therein estimated after microinjection of 1 microliter of 131I-albumin into the caudate nucleus, after single intraventricular injections, and during intraventricular infusions. Comparison of lymph at 7 and 25 h after intracerebral microinjection with efflux of radioactivity from whole brain suggests that about 50% of cleared radioactivity goes through lymph. Concentrations, normalized to cerebrospinal fluid (CSF), were much higher in lymph and retropharyngeal nodes after brain injection than after CSF injection or infusion. Also after brain injection, lymph and nodes contained more activity on injected side in contrast to lack of laterality after CSF administration. Calculation suggests that less than 30% of RISA cleared from brain can do so via a pool of well-mixed CSF. Analysis of tissues is compatible with much RISA draining by bulk flow via cerebral perivascular spaces plus passage from subarachnoid space of olfactory lobes into submucous spaces of nose and thus to lymph.

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Diagnostic challenges in neoplastic meningitis presenting as intracranial hypertension

BMJ Case Reports ◽

10.1136/bcr-2020-238808 ◽

2021 ◽

Vol 14 (3) ◽

pp. e238808

Author(s):

Santosh Sriram Andugulapati ◽

Akash Chheda ◽

Karan Desai ◽

Sangeeta Hasmukh Ravat

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypertension ◽

Neoplastic Meningitis ◽

Whole Body ◽

Csf Cytology ◽

Csf Analysis ◽

Pet Ct ◽

Pet Ct Scan ◽

Systemic Malignancy

A diagnosis of idiopathic intracranial hypertension should be considered only after careful exclusion of all possible aetiologies. We report a case of neoplastic meningitis presenting as intracranial hypertension with inconclusive repeated cerebrospinal fluid (CSF) cytology and MRI of brain, emphasising the importance of meticulous CSF analysis and role of early whole-body PET–CT scan for diagnosis of systemic malignancy.

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Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160044 ◽

2016 ◽

Vol 74 (4) ◽

pp. 337-350 ◽

Cited By ~ 28

Author(s):

Hansotto Reiber

Keyword(s):

Cerebrospinal Fluid ◽

Systematic Approach ◽

Diagnostic Methods ◽

Demyelinating Diseases ◽

Psychiatric Diseases ◽

Csf Flow ◽

Knowledge Based ◽

Csf Analysis ◽

Data Compilation ◽

Tumor Metastases

ABSTRACT The analysis of intrathecal IgG, IgA and IgM synthesis in cerebrospinal fluid (CSF) and evaluation in combined quotient diagrams provides disease-related patterns. The compilation with complementary parameters (barrier function, i.e., CSF flow rate, cytology, lactate, antibodies) in a cumulative CSF data report allows a knowledge-based interpretation and provides analytical and medical plausibility for the quality assessment in CSF laboratories. The diagnostic relevance is described for neurological and psychiatric diseases, for which CSF analysis can’t be replaced by other diagnostic methods without loss of information. Dominance of intrathecal IgM, IgA or three class immune responses give a systematic approach for Facial nerve palsy, Neurotrypanosomiasis, Opportunistic diseases, lymphoma, Neurotuberculosis, Adrenoleucodystrophy or tumor metastases. Particular applications consider the diagnostic power of the polyspecific antibody response (MRZ-antibodies) in multiple sclerosis, a CSF-related systematic view on differential diagnostic of psychiatric diseases and the dynamics of brain- derived compared to blood-derived molecules in CSF for localization of paracytes.

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Inflammatory cerebrospinal fluid analysis in cats: Clinical diagnosis and outcome

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2004.07.001 ◽

2005 ◽

Vol 7 (2) ◽

pp. 77-93 ◽

Cited By ~ 27

Author(s):

M. Singh ◽

D.J. Foster ◽

G. Child ◽

W.A. Lamb

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Cell Count ◽

Clinical Signs ◽

Central Nervous System Disease ◽

Nervous System Disease ◽

Differential Count ◽

System Disease ◽

Csf Analysis

The medical records of 62 cats with clinical signs of central nervous system disease and accompanying inflammatory cerebrospinal fluid (CSF) analysis were examined retrospectively to determine if signalment, clinical signs, CSF analysis and ancillary testing could accurately predict the type of central nervous system disease that was present. An inflammatory CSF was defined as one in which a total nucleated cell count was greater than 5 cells/μl or one in which the total nucleated cell count was normal but the nucleated cell differential count was abnormal. Sex, degree of CSF inflammation, neuroanatomical location and systemic signs provided little contributory information to the final diagnosis. In 63% of the cases a presumptive diagnosis could be made based on a combination of clinical signs, clinicopathological data and ancillary diagnostic tests. CSF analysis alone was useful only in the diagnosis of cats with feline infectious peritonitis, Cryptococcus species infection, lymphoma and trauma. Overall, despite extensive diagnostic evaluation, a specific diagnosis could not be made in 37% of cats. The prognosis for cats with inflammatory CSF was poor with 77% of cats surviving less than 1 year.

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Bacterial Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis: A Case Report and Review of the Literature

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/568169 ◽

2014 ◽

Vol 25 (5) ◽

pp. 249-251 ◽

Cited By ~ 24

Author(s):

Ryota Hase ◽

Naoto Hosokawa ◽

Makito Yaegashi ◽

Kiyoharu Muranaka

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Lumbar Puncture ◽

Early Stage ◽

Review Of The Literature ◽

Csf Analysis ◽

Cell Counts ◽

Csf Pleocytosis ◽

Cerebrospinal Fluid Pleocytosis ◽

Rule Out

Elevation of cerebrospinal fluid (CSF) cell count is a key sign in the diagnosis of bacterial meningitis. However, there have been reports of bacterial meningitis with no abnormalities in initial CSF testing. This type of presentation is extremely rare in adult patients. Here, a case involving an 83-year-old woman who was later diagnosed with bacterial meningitis caused byNeisseria meningitidisis described, in whom CSF at initial and second lumbar puncture did not show elevation of cell counts. Twenty-six non-neutropenic adult cases of bacterial meningitis in the absence of CSF pleocytosis were reviewed. The frequent causative organisms wereStreptococcus pneumoniaeandN meningitidis. Nineteen cases had bacteremia and seven died. The authors conclude that normal CSF at lumbar puncture at an early stage cannot rule out bacterial meningitis. Therefore, repeat CSF analysis should be considered, and antimicrobial therapy must be started immediately if there are any signs of sepsis or meningitis.

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Non-inflammatory cerebrospinal fluid delays the diagnosis and start of immunotherapy in anti-NMDAR encephalitis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170179 ◽

2018 ◽

Vol 76 (1) ◽

pp. 2-5 ◽

Cited By ~ 6

Author(s):

Mariana Espinola-Nadurille ◽

Paola Bautista-Gomez ◽

Jose Flores ◽

Veronica Rivas-Alonso ◽

Rodrigo Perez-Esparza ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Symptom Onset ◽

Correct Diagnosis ◽

Retrospective Data ◽

Csf Analysis ◽

Aspartate Receptor ◽

Nmdar Encephalitis ◽

Neuropsychiatric Manifestations ◽

Inflammatory Pattern ◽

Autoimmune Encephalopathy

ABSTRACT Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalopathy that presents with a wide variety of symptoms, including neuropsychiatric manifestations. The authors’ aim for this study was to analyze the results of paraclinical studies of patients with a diagnosis of anti-NMDAR encephalitis and the association between symptom onset and diagnosis, and start of immunotherapy. Retrospective data of 29 patients with anti-NMDAR encephalitis were gathered and analyzed. Abnormal EEG was found in 27 patients (93.1%), whereas MRI was abnormal in 19 patients (65.5%). In contrast, an inflammatory pattern on CSF analysis was found in only 13 patients (44.8%). The absence of pleocytosis or increased proteins in the CSF was associated with a longer time from symptom onset to diagnosis and treatment (p = 0.003). The authors conclude that noninflammatory CSF may delay the correct diagnosis and start of immunotherapy in anti-NMDAR encephalitis. In the presence of suggestive clinical features, extensive studies including EEG are recommended.

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