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Published on: June 11, 2012
Insights
Hypoglycorrhachia, or low cerebrospinal fluid glucose, is common in pediatric meningitis. Bacterial meningitis shows the lowest glucose levels, while hypoglycemia presents higher ratios.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Hypoglycorrhachia, defined as low cerebrospinal fluid (CSF) glucose, lacks a precise numerical threshold due to dynamic blood-CSF glucose equilibrium.
- Understanding the causes and diagnostic implications of hypoglycorrhachia is crucial in pediatric neurology.
Purpose of the Study:
- To investigate the causes and characteristics of hypoglycorrhachia in a pediatric cohort.
- To analyze the CSF/blood glucose ratios in various conditions associated with low CSF glucose.
Main Methods:
- Retrospective study of 181 pediatric patients with CSF glucose < 50 mg/100 ml or CSF/blood glucose ratio < 0.50.
- Analysis of patient diagnoses including bacterial meningitis, aseptic meningitis, meningeal carcinomatosis, subarachnoid hemorrhage, and hypoglycemia.
Main Results:
- Hypoglycorrhachia was observed in bacterial meningitis, aseptic meningitis, meningeal carcinomatosis, subarachnoid hemorrhage, and hypoglycemia.
- Bacterial meningitis predominantly showed markedly diminished CSF glucose values.
- Higher CSF/blood glucose ratios were noted in hypoglycemia and in neonates with low-normal blood glucose levels.
- Aseptic meningitis was the third most frequent cause of pediatric hypoglycorrhachia, following bacterial meningitis and hypoglycemia.
Conclusions:
- CSF glucose levels and CSF/blood glucose ratios vary significantly across different pediatric conditions causing hypoglycorrhachia.
- Positive CSF viral cultures can aid in early antibiotic cessation for specific meningitis cases with hypoglycorrhachia.
- Distinguishing between bacterial and viral meningitis is critical for appropriate management, especially when CSF glucose is low.
Abstract:
Hypoglycorrhachia (abnormally low cerebro spinal fluid glucose content) eludes exact numerical definition, largely because of the dynamic equilibrium between blood and CSF glucose. A group of 181 pediatric patients with a CSF glucose less than 50 mg/100 ml or a CSF/blood glucose ratio less than 0.50 were studied. Hypoglycorrhachia was present in patients with bacterial meningitis, aseptic meningitis, meningeal carcinomatosis, subarachnoid hemmorrhage, and hypoglycemia. Markedly diminished CSF glucose values were seen primarily in patients with bacterial meningitis. Higher CSF/blood glucose ratios predominated in those with hypoglycemia and neonates with low-normal blood sugars. Following bacterial meningitis and hypoglycemia, aseptic meningitis (including five children with documented enterovirus meningitis and one with documented mumps meningitis) was the third most common cause of hypoglycorrhachia in children. When readily available, positive CSF viral cultures may allow early cessation of antibiotic therapy in two types of patients with meningitis and hypoglycorrhachia: (1) those receiving previous recent antibiotic therapy, and (2) those with CSF findings more typical of a bacterial meningitis.
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