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CSF spectrophotometry for bilirubin--why and how?
1Department of Clinical Biochemistry, North Bristol NHS Trust (Frenchay Hospital), Bristol, UK. robert.beetham@nbt.nhs.uk
Scandinavian Journal of Clinical and Laboratory Investigation
|February 10, 2009
Summary
A negative head CT does not rule out subarachnoid hemorrhage (SAH). Spectrophotometry of cerebrospinal fluid (CSF) for bilirubin is the recommended diagnostic test for SAH.
Area of Science:
- Neurology
- Clinical Diagnostics
Background:
- A negative computed tomography (CT) scan of the head does not exclude subarachnoid hemorrhage (SAH).
- Cerebral angiography can identify aneurysms but does not confirm rupture and is resource-intensive.
- Cerebrospinal fluid (CSF) analysis for blood is limited; visual inspection for xanthochromia is unreliable.
Purpose of the Study:
- To review guidelines for CSF spectrophotometry in diagnosing SAH.
- To evaluate the effectiveness of CSF spectrophotometry for SAH detection.
Main Methods:
- Analysis of 5 years of data from 2302 CSF spectrophotometry scans.
- Review of established guidelines for spectrophotometry performance and interpretation.
Main Results:
- 92% of scans did not support SAH.
- 4% indicated the need for angiography to identify potential aneurysms.
- 4% were equivocal due to oxyhemoglobin interference with bilirubin detection.
Conclusions:
- Spectrophotometry of CSF for hemoglobin breakdown products (oxyhemoglobin and bilirubin) is the most appropriate investigation for suspected SAH.
- Guidelines for CSF spectrophotometry require ongoing review and modification.
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