EM Vivas · Cerebrospinal fluid interpretation
Cerebrospinal fluid interpretation — the data viva
An ACEM-style data viva on the ED CSF interpretation — three samples (a bacterial meningitis, a viral meningitis and a subarachnoid haemorrhage) are presented, and the candidate must interpret the appearance, the cell count, the glucose, the protein and the xanthochromia, name the diagnosis, and state the next step. Tests the candidate's ability to distinguish the bacterial from the viral from the tuberculous pattern, and a traumatic tap from a subarachnoid.
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Sample A — from a 24-year-old man with a fever of 39, a severe headache and a GCS of 14: turbid CSF with a neutrophil-predominant pleocytosis, low glucose and high protein.[2]
Sample B — from a 30-year-old woman with a thunderclap headache, a GCS of 15, a normal non-contrast CT at 2 hours and an LP at 6 hours: blood-stained CSF with a uniform red-cell count across tubes and a positive spectrophotometry.[3]
Sample C — from a 28-year-old man with a fever, a headache and a mild photophobia, a GCS of 15: clear CSF with a mild lymphocytic pleocytosis, normal glucose and a negative Gram stain.[2]
References5ShowHide
- [2]Brouwer MC, Tunkel AR, van de Beek D. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. Lancet, 2012.PMID 23141617
- [3]Perry JJ, Sivilotti MLA, Émond M, et al. Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. CMAJ, 2017.PMID 29133539
- [13]Cruickshank AM ACP Best Practice No 166: CSF spectrophotometry in the diagnosis of subarachnoid haemorrhage. Journal of clinical pathology, 2001.PMID 11684714
- [15]Kannarkat GT, Darrow J, Moghekar A Reassessing accuracy of blood cell correction factor for traumatic lumbar puncture. Journal of the neurological sciences, 2022.PMID 34929498
- [17]Young N, Thomas M Meningitis in adults: diagnosis and management. Internal medicine journal, 2018.PMID 30387309