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Hayrettin Tumani - One of the best experts on this subject based on the ideXlab platform.

  • s1 guidelines lumbar puncture and Cerebrospinal Fluid Analysis abridged and translated version
    Neurological Research and Practice, 2020
    Co-Authors: Hayrettin Tumani, H F Petereit, A Gerritzen, C C Gross, Andre Huss, S Isenmann, Sarah Jesse, Michael Khalil, Piotr Lewczuk, Jan Lewerenz
    Abstract:

    Cerebrospinal Fluid (CSF) Analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF Analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits. Recommendations (most important 3-5 recommendations on a glimpse): In view of the importance and developments in CSF Analysis, the S1 guideline “Lumbar puncture and Cerebrospinal Fluid Analysis” was recently prepared by the German Society for CSF Analysis and clinical neurochemistry (DGLN) and published in German in accordance with the guidelines of the AWMF (https://www.awmf.org). /uploads/tx_szleitlinien/030-141l_S1_Lumbalpunktion_und_Liquordiagnostik_2019-08.pdf). The present article is an abridged translation of the above cited guideline. The guideline has been jointly edited by the DGLN and DGN.

  • S1 guidelines “lumbar puncture and Cerebrospinal Fluid Analysis” (abridged and translated version)
    Neurological Research and Practice, 2020
    Co-Authors: Hayrettin Tumani, H F Petereit, A Gerritzen, C C Gross, Andre Huss, S Isenmann, Sarah Jesse, Michael Khalil, Piotr Lewczuk, Jan Lewerenz
    Abstract:

    Introduction Cerebrospinal Fluid (CSF) Analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF Analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits. Recommendations (most important 3-5 recommendations on a glimpse): 1. The indications and contraindications must be checked before lumbar puncture (LP) is performed, and sampling CSF requires the consent of the patient. 2. Puncture with an atraumatic needle is associated with a lower incidence of postpuncture discomfort. The frequency of postpuncture syndrome correlates inversely with age and body mass index, and it is more common in women and patients with a history of headache. The sharp needle is preferably used in older or obese patients, also in punctures expected to be difficult. 3. In order to avoid repeating LP, a sufficient quantity of CSF (at least 10 ml) should be collected. The CSF sample and the serum sample taken at the same time should be sent to a specialized laboratory immediately so that the emergency and basic CSF Analysis program can be carried out within 2 h. 4. The indication for LP in anticoagulant therapy should always be decided on an individual basis. The risk of interrupting anticoagulant therapy must be weighed against the increased bleeding risk of LP with anticoagulant therapy. 5. As a quality assurance measure in CSF Analysis, it is recommended that all cytological, clinical-chemical, and microbiological findings are combined in an integrated summary report and evaluated by an expert in CSF Analysis. Conclusions In view of the importance and developments in CSF Analysis, the S1 guideline “Lumbar puncture and Cerebrospinal Fluid Analysis” was recently prepared by the German Society for CSF Analysis and clinical neurochemistry (DGLN) and published in German in accordance with the guidelines of the AWMF ( https://www.awmf.org ). /uploads/tx_szleitlinien/030-141l_S1_Lumbalpunktion_und_Liquordiagnostik_2019-08.pdf). The present article is an abridged translation of the above cited guideline. The guideline has been jointly edited by the DGLN and DGN.

  • Strategies for Cerebrospinal Fluid Analysis - Integrated results report
    Nervenarzt, 2016
    Co-Authors: Hayrettin Tumani, P. Lange
    Abstract:

    : Cerebrospinal Fluid (CSF) Analysis requires a combined assessment of all individual test findings in an integrated total report in order to achieve a reliable and specific diagnostic conclusion. Such a standard assessment strategy allows the identification of disease-typical result patterns and plausibility checks to avoid analytical errors. The integrated total report consists of 1) a basic CSF program with cytological and protein chemical parameters, 2) an expanded CSF program with special parameters for detection of pathogens and markers of neurodegeneration and 3) a final contextual interpretation considering methodological and clinical aspects.

  • Guidelines on Cerebrospinal Fluid Analysis
    Cerebrospinal Fluid in Clinical Neurology, 2015
    Co-Authors: Harald Hegen, Finn Sellebjerg, Hayrettin Tumani, Charlotte E. Teunissen, Florian Deisenhammer
    Abstract:

    The examination of Cerebrospinal Fluid (CSF) is invaluable for the diagnosis of various neurological diseases. Whereas routine parameters such as white blood cell count, CSF/serum albumin quotient, CSF/serum glucose ratio, intrathecal fraction of immunoglobulins or cytological examination are used to obtain an integrative CSF report, there are also single disease-specific CSF biomarkers contributing to clinical diagnosis making. Furthermore, infectious agents can be detected in CSF either directly by microscopy and culture or indirectly by detection of antigens via polymerase chain reaction or of specific antibodies via serology. In this chapter, we discuss the diagnostic value of CSF referring to existing guidelines.

  • the utility of Cerebrospinal Fluid Analysis in patients with multiple sclerosis
    Nature Reviews Neurology, 2013
    Co-Authors: Martin Stangel, S Fredrikson, Edgar Meinl, Axel Petzold, Olaf Stuve, Hayrettin Tumani
    Abstract:

    Diagnosis of multiple sclerosis (MS) requires the exclusion of other possible diagnoses. For this reason, the Cerebrospinal Fluid (CSF) should be routinely analysed in patients with a first clinical event suggestive of MS. CSF Analysis is no longer mandatory for diagnosis of relapsing-remitting MS, as long as MRI diagnostic criteria are fulfilled. However, caution is required in diagnosing MS in patients with negative MRI findings or in the absence of CSF Analysis, as CSF investigation is useful to eliminate other causes of disease. The detection of oligoclonal IgG bands in CSF has potential prognostic value and is helpful for clinical decision-making. In addition, CSF Analysis is important for research into the pathogenesis of MS. Pathophysiological and neurodegenerative findings of inflammation in MS have been derived from CSF investigations. Novel CSF biomarkers, though not yet validated, have been identified for diagnosis of MS and for ascertaining disease activity, prognosis and response to treatment, and are likely to increase in number with modern detection techniques. In this Review, we summarize CSF findings that shed light on the differential diagnosis of MS, and highlight the potential of novel biomarkers for this disease that could advance understanding of its pathophysiology. © 2013 Macmillan Publishers Limited. All rights reserved.

Alejandro A Rabinstein - One of the best experts on this subject based on the ideXlab platform.

  • Significance of routine Cerebrospinal Fluid Analysis in subarachnoid hemorrhage.
    Journal of Neurosurgical Sciences, 2015
    Co-Authors: Tarun D. Singh, Alejandro A Rabinstein, Patrick R. Maloney, Sara E. Hocker
    Abstract:

    BACKGROUND: The aim of this paper was to determine the diagnostic value of Cerebrospinal Fluid (CSF) Analysis in the setting of aneurysmal subarachnoid hemorrhage (aSAH), hypothesizing that CSF Analysis is only critical in confirming suspected infection and may be useful in predicting and/or detecting delayed cerebral ischemia (DCI). METHODS: Retrospective review of consecutive adult patients diagnosed with aSAH from 1/2000 to 12/2013 at Mayo Clinic, Rochester, MN, USA with cerebral aneurysm(s) identified by vascular imaging, and CSF drawn within 14 days of the date of hemorrhage. RESULTS: We identified 741 patients during the study period, 167 met inclusion criteria and 356 samples were collected. First Median CSF samples were taken 5 (4-8) days postbleed. Multiple samples were taken in 94 (54.5%) patients and the mean number of samples per patient was 2.1. Ventriculitis, confirmed by growth of organism from CSF culture was present in 2 (1.2%) patients and one patient (0.6%) developed meningitis. CSF WBC count remained elevated throughout the 14 days, even when corrected for red blood cell count (RBC). Peak CSF RBCs occurred 2-4 days post bleed, and then gradually normalized. Maximum CSF RBCs did not correlate with modified Fisher grades (P=0.422). Delayed cerebral ischemia (DCI) was present in 86 (51.5%) patients and there was no difference in the CSF profile of patients with DCI compared with those without. CONCLUSIONS: Routine CSF sampling for cell count and chemistry in the setting of temporary diversion following aSAH appears to have little clinical benefit beyond the evaluation for infection.

  • thunderclap headache and normal computed tomographic results value of Cerebrospinal Fluid Analysis
    Mayo Clinic Proceedings, 2008
    Co-Authors: Stefan A Dupont, Edward M Manno, Eelco F. M. Wijdicks, Alejandro A Rabinstein
    Abstract:

    OBJECTIVE To determine the sensitivity, specificity, and negative and positive predictive values of Cerebrospinal Fluid (CSF) xanthochromia for detection of ruptured cerebral aneurysms in patients with thunderclap headache (sudden and severe headache with maximal intensity at onset). PATIENTS AND METHODS We identified patients who presented to our emergency department with symptoms of thunderclap headache between January 1, 1998, and January 1, 2008. Those with normal results on computed tomography (CT) of the head were selected for inclusion in the study. All consenting adult patients had undergone a lumbar puncture procedure for CSF Analysis. Xanthochromia was assessed by visual inspection. All patients with a normal CT result were further evaluated by conventional 4-vessel catheter angiography. If no aneurysms were detected in the initial study, the procedure was performed again within 7 to 14 days. All patients were followed up clinically for a mean period of approximately 29 months. RESULTS A total of 152 patients were identified (mean ± SD age, 44.7±15.8 years; 53 men). Cerebrospinal Fluid xanthochromia was present in 18 patients (12%), 13 (72%) of whom were ultimately diagnosed as having aneurysmal subarachnoid hemorrhage. A single patient who tested negative for xanthochromia and had a normal CT result was subsequently found to have a ruptured middle cerebral artery aneurysm. The sensitivity, specificity, positive predictive value, and negative predictive value of CSF xanthochromia for detection of cerebral aneurysms were 93%, 95%, 72%, and 99%, respectively. CONCLUSION Although not perfect, visual inspection of CSF in patients with a history suggestive of subarachnoid hemorrhage remains a highly valuable and simple test to detect a recently ruptured aneurysm.

Jan Lewerenz - One of the best experts on this subject based on the ideXlab platform.

  • s1 guidelines lumbar puncture and Cerebrospinal Fluid Analysis abridged and translated version
    Neurological Research and Practice, 2020
    Co-Authors: Hayrettin Tumani, H F Petereit, A Gerritzen, C C Gross, Andre Huss, S Isenmann, Sarah Jesse, Michael Khalil, Piotr Lewczuk, Jan Lewerenz
    Abstract:

    Cerebrospinal Fluid (CSF) Analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF Analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits. Recommendations (most important 3-5 recommendations on a glimpse): In view of the importance and developments in CSF Analysis, the S1 guideline “Lumbar puncture and Cerebrospinal Fluid Analysis” was recently prepared by the German Society for CSF Analysis and clinical neurochemistry (DGLN) and published in German in accordance with the guidelines of the AWMF (https://www.awmf.org). /uploads/tx_szleitlinien/030-141l_S1_Lumbalpunktion_und_Liquordiagnostik_2019-08.pdf). The present article is an abridged translation of the above cited guideline. The guideline has been jointly edited by the DGLN and DGN.

  • S1 guidelines “lumbar puncture and Cerebrospinal Fluid Analysis” (abridged and translated version)
    Neurological Research and Practice, 2020
    Co-Authors: Hayrettin Tumani, H F Petereit, A Gerritzen, C C Gross, Andre Huss, S Isenmann, Sarah Jesse, Michael Khalil, Piotr Lewczuk, Jan Lewerenz
    Abstract:

    Introduction Cerebrospinal Fluid (CSF) Analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF Analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits. Recommendations (most important 3-5 recommendations on a glimpse): 1. The indications and contraindications must be checked before lumbar puncture (LP) is performed, and sampling CSF requires the consent of the patient. 2. Puncture with an atraumatic needle is associated with a lower incidence of postpuncture discomfort. The frequency of postpuncture syndrome correlates inversely with age and body mass index, and it is more common in women and patients with a history of headache. The sharp needle is preferably used in older or obese patients, also in punctures expected to be difficult. 3. In order to avoid repeating LP, a sufficient quantity of CSF (at least 10 ml) should be collected. The CSF sample and the serum sample taken at the same time should be sent to a specialized laboratory immediately so that the emergency and basic CSF Analysis program can be carried out within 2 h. 4. The indication for LP in anticoagulant therapy should always be decided on an individual basis. The risk of interrupting anticoagulant therapy must be weighed against the increased bleeding risk of LP with anticoagulant therapy. 5. As a quality assurance measure in CSF Analysis, it is recommended that all cytological, clinical-chemical, and microbiological findings are combined in an integrated summary report and evaluated by an expert in CSF Analysis. Conclusions In view of the importance and developments in CSF Analysis, the S1 guideline “Lumbar puncture and Cerebrospinal Fluid Analysis” was recently prepared by the German Society for CSF Analysis and clinical neurochemistry (DGLN) and published in German in accordance with the guidelines of the AWMF ( https://www.awmf.org ). /uploads/tx_szleitlinien/030-141l_S1_Lumbalpunktion_und_Liquordiagnostik_2019-08.pdf). The present article is an abridged translation of the above cited guideline. The guideline has been jointly edited by the DGLN and DGN.

Demitri A. Fomin - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal Fluid Analysis
    American Family Physician, 2003
    Co-Authors: D A Seehusen, Mark M. Reeves, Demitri A. Fomin
    Abstract:

    Lumbar puncture is frequently performed in primary care. Properly interpreted tests can make Cerebrospinal Fluid (CSF) a key tool in the diagnosis of a variety of diseases. Proper evaluation of CSF depends on knowing which tests to order, normal ranges for the patient's age, and the test's limitations. Protein level, opening pressure, and CSF-to-serum glucose ratio vary with age. Xanthochromia is most often caused by the presence of blood, but several other conditions should be considered. The presence of blood can be a reliable predictor of subarachnoid hemorrhage but takes several hours to develop. The three-tube method, commonly used to rule out a central nervous system hemorrhage after a "traumatic tap," is not completely reliable. Red blood cells in CSF caused by a traumatic tap or a subarachnoid hemorrhage artificially increase the white blood cell count and protein level, thereby confounding the diagnosis. Diagnostic uncertainty can be decreased by using accepted corrective formulas. White blood cell differential may be misleading early in the course of meningitis, because more than 10 percent of cases with bacterial infection will have an initial lymphocytic predominance and viral meningitis may initially be dominated by neutrophils. Culture is the gold standard for determining the causative organism in meningitis. However, polymerase chain reaction is much faster and more sensitive in some circumstances. Latex agglutination, with high sensitivity but low specificity, may have a role in managing partially treated meningitis. To prove herpetic, cryptococcal, or tubercular infection, special staining techniques or collection methods may be required.

Tomoyuki Sasagawa - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal Fluid Analysis in Kirisawa-Urayama type uveitis
    Japanese Journal of Ophthalmology, 1999
    Co-Authors: Yuko Iizuka, Tomoyuki Sasagawa
    Abstract:

    Abstract Purpose: We investigated whether viral encephalitis could occur in patients with Kirisawa-Urayama type uveitis by analyzing the Cerebrospinal Fluid (CSF). Methods: CSF samples were aspirated from nine patients with Kirisawa-Urayama type uveitis and assayed for local antibody production and the presence of herpesvirus DNA. Results: Seven cases had mild CSF pleocytosis. In six of seven cases who underwent CSF antibody Analysis, we found intrathecal antibody production against herpes simplex virus or varicella-zoster virus which were the causative viruses diagnosed from intraocular Fluid in each patient. Polymerase chain reaction (PCR) assay was used to search for virus DNA in the CSF of six patient, but all were negative. Conclusions: The results of this study suggest that Kirisawa-Urayama type uveitis is often accompanied with optic nerve involvement and intrathecal antibody production against causative viruses, but we could not find any viral encephalitis. (J Jpn Ophthalmol Soc 103:442–448, 1999)

  • Cerebrospinal Fluid Analysis in Kirisawa-Urayama type uveitis
    Nippon Ganka Gakkai zasshi, 1999
    Co-Authors: Yuko Iizuka, Tomoyuki Sasagawa
    Abstract:

    We investigated whether viral encephalitis could occur in patients with Kirisawa-Urayama type uveitis by analysing the Cerebrospinal Fluid (CSF). CSF samples were aspirated from nine patients with Kirisawa-Urayama type uveitis and assayed for local antibody production and the presence of herpesvirus DNA. Seven cases had mild CSF pleocytosis. In six of seven cases who underwent CSF antibody Analysis, we found intrathecal antibody production against herpes simplex virus or varicella-zoster virus which were the causative viruses diagnosed from intraocular Fluid in each patients. Polymerase chain reaction (PCR) assay was used to search for virus DNA in the CSF of six patients, but all were negative. The results of this study suggest that Kirisawa-Urayama type uveitis is often accompanied with optic nerve involvement and intrathecal antibody production against causative viruses, but we could not find any viral encephalitis.