The presentation and diagnostic utility of xanthochromia in current practice
Background: Cerebrospinal fluid (CSF) xanthochromia, when diagnosed with spectrophotometry, is highly sensitive and specific for subarachnoid hemorrhage. However, most laboratories in North America currently rely on visual inspection rather than spectrophotometry for assessment of xanthochromia, mak...
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| Language: | English |
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Elsevier
2024-12-01
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| Series: | JEM Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773232024000464 |
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| author | Marzia Maliha Paulina Henriquez-Rojas Varsha Muddasani Narges Rahimi Stella Adetokunbo Saman Zafar |
| author_facet | Marzia Maliha Paulina Henriquez-Rojas Varsha Muddasani Narges Rahimi Stella Adetokunbo Saman Zafar |
| author_sort | Marzia Maliha |
| collection | DOAJ |
| description | Background: Cerebrospinal fluid (CSF) xanthochromia, when diagnosed with spectrophotometry, is highly sensitive and specific for subarachnoid hemorrhage. However, most laboratories in North America currently rely on visual inspection rather than spectrophotometry for assessment of xanthochromia, making it less specific for the presence of hemoglobin degradation products and inclusive of other etiologies for yellow discoloration of the cerebrospinal fluid. Case report: We present a series of cases from our inner-city community hospital to demonstrate how CSF xanthochromia is not specific to subarachnoid hemorrhage. There are three patients who presented with yellow-colored CSF but were ultimately diagnosed with meningitis or leptomeningeal carcinomatosis and one patient who presented with pink-colored CSF and was diagnosed with a true aneurysmal bleed. Why should an emergency physician be aware of this: Subarachnoid hemorrhage is a life-threatening emergency that is always on an emergency physician's list of differential diagnoses in a patient with acute headache. Our series of cases suggest the importance of correctly interpreting lumbar puncture findings and relying on spectrophotometry rather than visual inspection of the CSF to rule xanthochromia—and, consequently, subarachnoid hemorrhage—in or out. |
| format | Article |
| id | doaj-art-daae3dd2d16a4e7cb8e523f6daec691f |
| institution | OA Journals |
| issn | 2773-2320 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JEM Reports |
| spelling | doaj-art-daae3dd2d16a4e7cb8e523f6daec691f2025-08-20T01:54:15ZengElsevierJEM Reports2773-23202024-12-013410011610.1016/j.jemrpt.2024.100116The presentation and diagnostic utility of xanthochromia in current practiceMarzia Maliha0Paulina Henriquez-Rojas1Varsha Muddasani2Narges Rahimi3Stella Adetokunbo4Saman Zafar5Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA, 19107, USA; Corresponding author. Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA, 19107, USA.Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USAAlbert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USAAlbert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USAAlbert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USAAlbert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USABackground: Cerebrospinal fluid (CSF) xanthochromia, when diagnosed with spectrophotometry, is highly sensitive and specific for subarachnoid hemorrhage. However, most laboratories in North America currently rely on visual inspection rather than spectrophotometry for assessment of xanthochromia, making it less specific for the presence of hemoglobin degradation products and inclusive of other etiologies for yellow discoloration of the cerebrospinal fluid. Case report: We present a series of cases from our inner-city community hospital to demonstrate how CSF xanthochromia is not specific to subarachnoid hemorrhage. There are three patients who presented with yellow-colored CSF but were ultimately diagnosed with meningitis or leptomeningeal carcinomatosis and one patient who presented with pink-colored CSF and was diagnosed with a true aneurysmal bleed. Why should an emergency physician be aware of this: Subarachnoid hemorrhage is a life-threatening emergency that is always on an emergency physician's list of differential diagnoses in a patient with acute headache. Our series of cases suggest the importance of correctly interpreting lumbar puncture findings and relying on spectrophotometry rather than visual inspection of the CSF to rule xanthochromia—and, consequently, subarachnoid hemorrhage—in or out.http://www.sciencedirect.com/science/article/pii/S2773232024000464XanthochromiaSubarachnoid hemorrhageMeningitisLeptomeningeal carcinomatosisLumbar puncture |
| spellingShingle | Marzia Maliha Paulina Henriquez-Rojas Varsha Muddasani Narges Rahimi Stella Adetokunbo Saman Zafar The presentation and diagnostic utility of xanthochromia in current practice JEM Reports Xanthochromia Subarachnoid hemorrhage Meningitis Leptomeningeal carcinomatosis Lumbar puncture |
| title | The presentation and diagnostic utility of xanthochromia in current practice |
| title_full | The presentation and diagnostic utility of xanthochromia in current practice |
| title_fullStr | The presentation and diagnostic utility of xanthochromia in current practice |
| title_full_unstemmed | The presentation and diagnostic utility of xanthochromia in current practice |
| title_short | The presentation and diagnostic utility of xanthochromia in current practice |
| title_sort | presentation and diagnostic utility of xanthochromia in current practice |
| topic | Xanthochromia Subarachnoid hemorrhage Meningitis Leptomeningeal carcinomatosis Lumbar puncture |
| url | http://www.sciencedirect.com/science/article/pii/S2773232024000464 |
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