Artikel
Is lumbar puncture mandatory to exclude subarachnoid haemorrhage in patients with negative CT and CTA imaging?
Ist eine Lumbalpunktion erforderlich, um Subarachnoidalblutungen bei Patienten mit negativer CT- und negativer CTA-Bildgebung auszuschließen?
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Autoren
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Christian Eisenring
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland; Insel University Hospital Bern, Neurochirurgie, Bern, Switzerland
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Eya Khadhraoui
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland; Universitätsmedizin Göttingen, Neuroradiologie, Göttingen, Deutschland
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Hiroki Danura
- Kantonsspital St. Gallen, Klinik für Neurochirurgie, St. Gallen, Switzerland
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Trang Nguyen Thi
- Insel University Hospital Bern, Neurochirurgie, Bern, Switzerland
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Tatiana Chacon
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Marios Nikos Psychogios
- Universitätsmedizin Göttingen, Neuroradiologie, Göttingen, Deutschland
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Björn Sommer
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Tammam Abboud
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Missing the diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) could be life threatening. In patients with sudden severe headache and a negative computed tomography (CT) scan, a lumbar puncture (LP) is usually performed to rule in or out aSAH. The aim of this study was to determine the value of CT and CT-angiography (CTA) imaging among patients with suspicion of aSAH, who have no neurological deficits and to identify the diagnostic benefit of additional lumbar puncture in detecting aSAH.
Methods: We conducted a retrospective, observational, follow-up study using our radiological database and the searching terms “subarachnoid haemorrhage”, “aneurysm” and “headache” to retrieve all patients who presented to the emergency department from 01.01.2010 to 30.10.2018. The cases were scanned with a SOMATOM Definition AS CT (128 slices). Patients with objective neurological deficits or diseases mandating invasive diagnosis were excluded. The included cases were followed up with the help of the clinical patient registry. LP and CT-angiography results were searched, documented, and presented by descriptive statistics.
Results: We identified 4313 patients with suspicion of aSAH and found 94 (2%) patients with initially negative findings on CT- and CTA-imaging and no objective neurologic deficit at presentation. These patients were followed up for a total of 114 patient-years. 36 of these 94 cases (38%) had a documented LP. Cerebrospinal fluid (CSF) was clean in 26 cases (72%). In 10 of 36 cases (28%) blood traces or xanthochromia were detected in the CSF samples. Six of them (17%) had a non-aneurysmal SAH and underwent a digital subtraction angiography, which could not detect any aneurysm or vascular malformation. The remaining 4 patients were diagnosed with ischemic stroke, migraine or atypical face pain. While CT- and CTA-imaging hat no false negative results, false positive rate for aSAH in LP was (4/36) 11%.
Conclusion: Our data suggest that with contemporary CT-imaging modalities LP has no benefit in detecting aSAH in patients who have negative CT-imaging and no neurological deficit. Furthermore, false positive results of LP can lead to unnecessary invasive diagnostic measures such as digital subtraction angiography.
