Distinguishing traumatic lumbar puncture from true subarachnoid hemorrhage

Kaushal H. Shah, Jonathan A. Edlow

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

Abstract

The lumbar puncture (LP) is a relatively simple diagnostic test. However, significant diagnostic ambiguity can arise when trauma from the needle causes bleeding into the subarachnoid space, especially when trying to make the diagnosis of subarachnoid hemorrhage (SAH). The purpose of this article is to assist emergency physicians in distinguishing traumatic LPs from SAH. To correctly interpret the findings of a traumatic tap, a few concepts must be understood. Timing of the LP in relation to the onset of the SAH affects the results of the cerebrospinal fluid (CFS) analysis; the typical findings will change with time. With a few caveats, xanthochromia, the yellow discoloration of the CSF resulting from hemoglobin catabolism, is often critical in making a diagnosis of SAH. A few of the most essential methods for distinguishing traumatic LP from true SAH include: the "three tube test," opening pressure, and inspection for visual xanthochromia.

Original languageEnglish
Pages (from-to)67-74
Number of pages8
JournalJournal of Emergency Medicine
Volume23
Issue number1
DOIs
StatePublished - May 2002
Externally publishedYes

Keywords

  • Lumbar puncture
  • Subarachnoid hemorrhage
  • Traumatic tap
  • Xanthochromia

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