Misinterpretation of Cerebrospinal Fluid Gram Stain

PEDIATRICS ◽  
1974 ◽  
Vol 54 (3) ◽  
pp. 360-362
Author(s):  
Ronald W. Joyner ◽  
Ziad H. Idriss ◽  
Catherine M. Wilfert
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Respiratory Distress ◽  
Lumbar Puncture ◽  
False Positive ◽  
Tracheal Aspirate ◽  
Black Female ◽  
Female Infant ◽  
Penicillin G ◽  
Gram Stain

Several causes for false-positive Gram stains of cerebrospinal fluid (CSF) have been recorded previously! We report here an additional cause for misinterpretation of the cerebrospinal fluid Gram stain which is probably related to the use of an open needle to perform the lumbar puncture. CASE REPORT The patient was a 1,300-gm black female infant, delivered after a 33-week gestation, who developed mild respiratory distress and hyperbilirubinemia which resolved spontaneously within one week. She received penicillin G and kanamycin for her first five days of life because of apnea and bradycardia, but blood, urine, CSF, and a culture of the tracheal aspirate obtained prior to therapy were all negative for bacteria.

Factitious Meningitis: A Recurring Problem

1988 ◽  
Vol 9 (11) ◽  
pp. 501-503 ◽  
Author(s):  
Robert L. Penn ◽  
Richard Normand ◽  
Stephen A. Klotz
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Retrospective Review ◽  
False Positive ◽  
Commercial Products ◽  
Gram Negative ◽  
Specimen Tube

AbstractAlthough gram-negative meningitis is rare in our hospital, between July, 1982 and July, 1983 clusters of cerebrospinal fluid (CSF) smears were reported positive for gram-negative bacilli. Fourteen specimens were obtained by diagnostic lumbar punctures, and one was obtained during a myelogram. No CSF cultures were positive, and a diagnosis of factitious meningitis was eventually established for each patient. Nonviable gram-negative bacilli were found in 6.7% of manometers, and 23.3% to 90% of the specimen tubes tested from the same lots of commercial lumbar puncture trays. It was estimated that there were between 44 and 333 organisms per specimen tube. Two lots of the commercial myelogram trays yielded nonviable gram-negative bacilli from 50% of the specimen tubes and 33.3% of the manometers tested. Retrospective review of laboratory records for 1982 and 1983 revealed 23 total CSF smears positive for gram-negative bacilli. No CSF grew gram-negative bacilli, and chart reviews confirmed a diagnosis of factitious meningitis in each case. In addition to the clusters of false-positive smears, this had occurred sporadically in both years. The problem did not recur after separate sterile tubes were provided for CSF collection. Physicians and laboratories should be aware that nonviable contaminants in commercial products may be a source of false-positive CSF gram-stained smears.

scholarly journals Treatment of Ruptured Meningocele Post-Brachial Plexus Surgery: Potential Life-Threatening Complication-An Unique Case Report of Management of Ruptured Meningocele Post-Brachial Plexus Surgery to Avoid Dreadful Complication

2021 ◽  
Vol 11 (7) ◽  
Author(s):  
B. Lad Parag ◽  
Ahire Pankaj ◽  
Tanpure Sanket
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Brachial Plexus ◽  
Lumbar Puncture ◽  
Brachial Plexus Injury ◽  
Accurate Diagnosis ◽  
Post Surgery ◽  
Glucose Test ◽  
Beta 2 ◽  
Brachial Plexus Surgery

Introduction: Formation of meningocele in brachial plexus injury is known and can be diagnosed on magnetic resonance imaging (MRI). It is mainly reported in brachial plexus root avulsion injuries and does not require specific treatment. We report accurate diagnosis and management of dreadful complication due to rupture of meningocele post-brachial plexus exploration. Case Report: A 23-year-old engineer presented at 4 months post-bike accident right side extended brachial plexus injury involving C5, C6, and C7. On MRI, he had meningocele in C6-7 root region. We performed supraclavicular exploration of brachial plexus and distal nerve transfers for shoulder abduction and elbow flexion. During surgery, the meningocele was ruptured. As the cyst was deep and extending toward apex of lung, the diagnosis of fluid drained had to be distinguished from pleural fluid with cerebrospinal fluid (CSF). We found hemo-glucose test and beta-2-transferrin levels are mandatory to confirm the diagnosis. Post-surgery, the patient had drainage of almost 500 cc of CSF from wound every day for 3 days. This was managed by repeat MRI and finally lumbar puncture drainage helped to seal the meningocele in neck. Conclusion: Meningocele in brachial plexus injury is common but rupture of cyst can be fatal. To confirm the origin of fluid, beta-2-transferin level is more specific test than the hemo-glucose test. Lumbar puncture and drainage away from neck can be more reliable modality of treatment in case of intraoperative rupture of such cysts if drainage is excessive postoperatively. Keywords: Meningocele rupture, cerebrospinal fluid leak, accurate diagnosis, management.

Factitious Meningitis: A Recurring Problem

1988 ◽  
Vol 9 (11) ◽  
pp. 501-503 ◽  
Author(s):  
Robert L. Penn ◽  
Richard Normand ◽  
Stephen A. Klotz
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Retrospective Review ◽  
False Positive ◽  
Commercial Products ◽  
Gram Negative ◽  
Specimen Tube

AbstractAlthough gram-negative meningitis is rare in our hospital, between July, 1982 and July, 1983 clusters of cerebrospinal fluid (CSF) smears were reported positive for gram-negative bacilli. Fourteen specimens were obtained by diagnostic lumbar punctures, and one was obtained during a myelogram. No CSF cultures were positive, and a diagnosis of factitious meningitis was eventually established for each patient. Nonviable gram-negative bacilli were found in 6.7% of manometers, and 23.3% to 90% of the specimen tubes tested from the same lots of commercial lumbar puncture trays. It was estimated that there were between 44 and 333 organisms per specimen tube. Two lots of the commercial myelogram trays yielded nonviable gram-negative bacilli from 50% of the specimen tubes and 33.3% of the manometers tested. Retrospective review of laboratory records for 1982 and 1983 revealed 23 total CSF smears positive for gram-negative bacilli. No CSF grew gram-negative bacilli, and chart reviews confirmed a diagnosis of factitious meningitis in each case. In addition to the clusters of false-positive smears, this had occurred sporadically in both years. The problem did not recur after separate sterile tubes were provided for CSF collection. Physicians and laboratories should be aware that nonviable contaminants in commercial products may be a source of false-positive CSF gram-stained smears.

scholarly journals Benign Intracranial Hypertension Due to Hypoparathyroidism: A Case Report

2022 ◽  
Vol 12 ◽  
Author(s):  
Giorgia Sforza ◽  
Annalisa Deodati ◽  
Romina Moavero ◽  
Laura Papetti ◽  
Ilaria Frattale ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
Clinical Manifestations ◽  
Nausea And Vomiting ◽  
Benign Intracranial Hypertension ◽  
Blood Tests ◽  
Organ Systems

Objective: The objective of this study is to present the rare case of a young girl with idiopathic intracranial hypertension secondary to hypoparathyroidism.Background: Idiopathic intracranial hypertension is a neurological syndrome characterized by elevated intracranial pressure (> 25 cmH2O) in the absence of intracerebral abnormalities or hydrocephalus. The pathophysiology of idiopathic intracranial hypertension is unknown, and rare cases of idiopathic intracranial hypertension secondary to hypoparathyroidism have been described. It is supposed that hypocalcemia causes decrease in the absorption of cerebrospinal fluid in arachnoidal granulations.Methods: The workup of the girl with idiopathic intracranial hypertension and hypoparathyroidism included physical examination, blood tests, diagnostic imaging, and lumbar puncture.Results: We present a 9-year-old female patient who was hospitalized for headache associated with nausea and vomiting for 3 weeks. She underwent an ophthalmologic examination that revealed papilledema. Lumbar puncture revealed an opening pressure of 65 cm H2O; cerebrospinal fluid analysis and brain computed tomography scan were normal. The patient started taking acetazolamide. Blood tests revealed hypocalcemia associated with high phosphorus level and undetectable PTH hormone, which led us to suspect hypoparathyroidism. She had never had cramps, paraesthesias, or tetany. Chvostek's and Trousseau's signs were positive. In the neck ultrasonography, parathyroids were not visible. Oral supplementation with calcitriol and calcium was started. Headache, nausea, and vomiting immediately disappeared after the lumbar puncture, and the papilledema improved gradually.Conclusions: Several anecdotal cases of idiopathic intracranial hypertension secondary to hypoparathyroidism have been described. However, our case report is of particular interest, since the child did not present with typical neurological hypoparathyroidism symptoms. Therefore, we recommend that hypoparathyroidism should be included in diagnostic investigations on children with clinical findings of idiopathic intracranial hypertension, because clinical manifestations of hypoparathyroidism are variable and may involve almost all organ systems.

scholarly journals Epidural cerebrospinal fluid collection following lumbar puncture in an adult patient: A case report and literature review

2018 ◽  
Vol 9 (1) ◽  
pp. 169 ◽  
Author(s):  
Edward Monaco III ◽  
Jonathon Cavaleri ◽  
JenniferL Perez ◽  
Alp Ozpinar ◽  
Nima Alan
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Literature Review ◽  
Adult Patient ◽  
Lumbar Puncture ◽  
Fluid Collection

scholarly journals Welling-up of cerebrospinal fluid is a sign of remote supratentorial hemorrhage during microvascular decompression: a case report

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Maidinamu Yakufujiang ◽  
Yoshinori Higuchi ◽  
Shogo Wakita ◽  
Kentaro Horiguchi ◽  
Shiro Ikegami ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Microvascular Decompression

scholarly journals The needle has been blunt for 20 years

2010 ◽  
Vol 23 (2) ◽  
pp. 330-331
Author(s):  
Brendan Silbert ◽  
David Scott ◽  
Lisbeth Evered ◽  
Paul Maruff
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Sampling Unit

The growing need for lumbar puncture in order to obtain cerebrospinal fluid (CSF) for the diagnosis Alzheimer's disease is becoming increasingly apparent (Herskovits and Growdon, 2010). The concept of a CSF sampling unit specializing in lumbar puncture would seem the most plausible solution. Physicians and interns are not necessarily skilled in the procedure and neurologists perform lumbar puncture rarely.

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