Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-24T17:59:17.874Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of lumbar puncture in the diagnosis of subarachnoid hemorrhage when computed tomography is unavailable

Published online by Cambridge University Press:  21 May 2015

David Mann
David Mann*
Affiliation:
Emergency Department, Powell River General Hospital, Powell River, BC
*
Powell River General Hospital, 5000 Joyce Ave., Powell River BC V8A 5R3

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Subarachnoid hemorrhage (SAH) is an important but uncommon condition in the differential diagnosis of acute headache. Most authorities recommend that patients with suspected SAH undergo noncontrast computed tomography (CT) as a first diagnostic intervention. If the results of the CT scan are negative, a lumbar puncture should be performed. Many nonurban Canadian hospitals do not have CT scanners and must either transfer patients or consider performing lumbar puncture prior to CT. In selected patients, performing lumbar puncture first may be an option, but timing of the procedure and the interpretation of results is important.

Keywords

Subarachnoid hemorrhagelumbar puncturecomputed tomographyrural emergency
Type
Small Urban and Rural Issues Médecine rurale et des petits centres urbains
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 2 , March 2002 , pp. 102 - 105
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Edlow, JA, Caplan, LR.Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med 2000;342:29–36.CrossRefGoogle ScholarPubMed
2.Schull, MJ.Lumbar Puncture First? An old test and a new approach to lone acute sudden headaches. CJEM 1999;1(2):99–102.CrossRefGoogle Scholar
3.Evans, RW.Diagnostic testing for the evaluation of headaches [review]. Neurol Clin 1996;14(1):1–26.CrossRefGoogle ScholarPubMed
4.Clinical policy on the initial approach to adolescents and adults presenting to the emergency department with a chief complaint of headache. American College of Emergency Physians. Ann Emerg Med 1996;27(6):821–44.Google Scholar
5.Guertler, AT.Pearls, pitfalls and updates. The clinical practice of emergency medicine. Emerg Med Clin N Am 1997;15:303–5.CrossRefGoogle ScholarPubMed
6.Linn, FH, Wijdicks, EF, van der Graaf, Y, Weerdesteyn-van Vliet, F, Bartel, N, Gijn, J.Prospective study of sentinel headaches in aneurysmal subarachnoid hemorrhage. Lancet 1994;344:590–3.Google Scholar
7.Lledo, A, Calandra, L, Martinez-Menendez, B, Perez-Sempere, A.acute headache of recent onset and subarachnoid hemorrhage: a prospective study. Headache 1994;34:172–4.Google Scholar
8.Ravel, R.Clinical laboratory medicine. 6th ed. St. Louis (MO): Mosby–Year Book Inc.; 1995. p. 303.Google Scholar
9.Wasserberg, J, Barlow, P.Lesson of the week. Lumbar puncture still has an important role in diagnosing subarachnoid haemorrhage. BMJ 1997;315:1598–9.Google Scholar
10.Roberts, JR.Clinical procedures in emergency medicine. 3rd ed. Philadelphia: WB Saunders Co.; 1998. p. 1055–6.Google Scholar
11.Soderstrom, CE.Diagnostic significance of CSF spectrophotometry and computer tomography in cerebrovascular disease. A comparative study in 231 cases. Stroke 1977;8(5):606–12.Google Scholar
12.Hillman, J.Should computer tomography scanning replace lumbar puncture in the diagnostic process in suspected subarachnoid hemorrhage? Surg Neurol 1986;26:547–50.Google Scholar
13.Duffy, GP.Lumbar puncture in spontaneous subarachnoid hemorrhage. BMJ 1982;285:1163–4.CrossRefGoogle Scholar
14.MacDonald, A, Mendelow, AD.Xanthochromia revisited: a reevaluation of lumbar puncture and ct scanning in the diagnosis of subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 1988;51:342–4.Google Scholar