title: Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?
abstract: Subarachnoid haemorrhage (SAH) has a high mortality and morbidity rate. Early SAH diagnosis allows the early treatment of a ruptured cerebral aneurysm, which improves the prognosis. Diagnostic cerebrospinal fluid (CSF) analyses may be performed after a negative computed tomography scan, but the precise analytical methods to be used have been debated. Here, we summarize the scientific evidence for different CSF methods for SAH diagnosis and describe their implementation in different countries. The principle literature search was conducted using PubMed and Scopus with the search items "cerebrospinal fluid", "subarachnoid haemorrhage", and "diagnosis". CSF analyses for SAH include visual examination, red blood cell counts, spectrophotometry for oxyhaemoglobin or bilirubin determination, CSF cytology, and ferritin measurement. The methods vary in availability and performance. There is a consensus that spectrophotometry has the highest diagnostic performance, but both oxyhaemoglobin and bilirubin determinations are susceptible to important confounding factors. Visual inspection of CSF for xanthochromia is still frequently used for diagnosis of SAH, but it is advised against because spectrophotometry has a superior diagnostic accuracy. A positive finding of CSF bilirubin is a strong indicator of an intracranial bleeding, whereas a positive finding of CSF oxyhaemoglobin may indicate an intracranial bleeding or a traumatic tap. Where spectrophotometry is not available, the combination of CSF cytology for erythrophages or siderophages and ferritin is a promising alternative.
authors.forename: Karin
authors.initials: K
authors.lastname: Nagy
authors.forename: Ina
authors.initials: I
authors.lastname: Skagervik
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Tumani
authors.forename: Axel
authors.initials: A
authors.lastname: Petzold
authors.forename: Manfred
authors.initials: M
authors.lastname: Wick
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Kühn
authors.forename: Manfred
authors.initials: M
authors.lastname: Uhr
authors.forename: Axel
authors.initials: A
authors.lastname: Regeniter
authors.forename: Johannes
authors.initials: J
authors.lastname: Brettschneider
authors.forename: Markus
authors.initials: M
authors.lastname: Otto
authors.forename: Jörg
authors.initials: J
authors.lastname: Kraus
authors.forename: Florian
authors.initials: F
authors.lastname: Deisenhammer
authors.forename: Ronald
authors.initials: R
authors.lastname: Lautner
authors.forename: Kaj
authors.initials: K
authors.lastname: Blennow
authors.forename: Leslie
authors.initials: L
authors.lastname: Shaw
authors.forename: Henrik
authors.initials: H
authors.lastname: Zetterberg
authors.forename: Niklas
authors.initials: N
authors.lastname: Mattsson
mesh_terms: D019963:Clinical Chemistry Tests / Q000379:methods*; D004906:Erythrocyte Count; D006801:Humans; D013053:Spectrophotometry; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D013548:Sweden