[Reasons in favor of lumbar puncture diagnosis (or lavage)].
In patients with strong suspicion of SAH, CT is the initial diagnostic procedure of choice. A lumbar puncture (LP) should be done if a CT is not available. If the patient has no focal deficit or papilloedema there is a little risk in LP. When a CT is negative there can be indication to do a LP: small leaks can be overlooked by CT, and they are often important premonitory events preceding larger and severe haemorrhages. The accuracy of CT in documenting SAH diminishes after 24 hours: thereafter, diagnosis is often dependent on LP. In some cases LP can be useful because the procedure may alleviate headache and remove some blood. LP can also quantify cerebro-spinal fluid (CSF) pressure, provide a baseline for future CSF determination, and allow the study of some parameters like arachidonate metabolites, lactic acid, fibrinogen degradation products (FDP) and thrombin-antithrombin complex (TAT).
Divisione di Neurochirurgia, Ospedale Nuovo Pellegrini, Napoli.
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Schisano
D006801:Humans; D013129:Spinal Puncture / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000175:diagnosis*
Le ragioni a favore della rachicentesi diagnostica (o di lavaggio).