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Vol. 22. Issue 2.
Pages 157-161 (January 2011)
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Vol. 22. Issue 2.
Pages 157-161 (January 2011)
Normal ventricular-CSF may confound the diagnosis of tuberculous meningitis hydrocephalus
LCR ventricular normal: un factor de confusión en el diagnóstico de hidrocefalia por meningitis tuberculosa
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S. Alfayate-Miguélez, L. Marín-Vives
Unidad Pediátrica de Enfermedades Infecciosas, Hospital Universitario “Virgen de la Arrixaca”, Murcia
L. Martínez-Lage-Azorín*, S. García-Martínez**, M.J. Almagro***, J.F. Martínez-Lage***,
Corresponding author
juanf.martinezlage@cablemurcia.com

Correspondencia: Servicio Regional de Neurocirugía. Hospital Universitario “Virgen de la Arrixaca”. 30120 El Palmar, Murcia.
* Servicio de Microbiología, Hospital Universitario “Virgen de la Arrixaca”, Murcia
** Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario “Virgen de la Arrixaca”, Murcia
*** Servicio Regional de Neurocirugía. Hospital Universitario “Virgen de la Arrixaca”, Murcia Unidad Pediátrica de Enfermedades Infecciosas
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Summary
Background

The standard procedure for the diagnosis of central nervous system (CNS) infections consists of cerebrospinal fluid (CSF) sampling, which is usually accomplished by a lumbar puncture. However, in some patients presenting with acute hydrocephalus submitted to immediate CSF drainage, the fluid is customarily obtained from the placed draining system. In addition, the CSF obtained from the ventricular and lumbar spaces in some cases may show unusual differences, both in physiological and pathological conditions.

Illustrative cases

We report two children who presented with confounding results in the initial studies of their ventricular and lumbar CSF who were subsequently diagnosed with tuberculous meningitis, causing delay in diagnosis and treatment.

Aim

By reporting these cases, we wanted to alert the treating physician about the possibility of this discrepancy to avoid the delayed diagnosis and management of the affected patients.

Discussion

We comment on the possible pathophysiological mechanisms that may result in this dissociation in ventricular and lumbar CSF composition.

Conclusions

Normal results in CSF studies, especially those of the ventricular fluid, do not always rule out the presence of tuberculous meningitis. We suggest obtaining a CSF sample from the lumbar subarachnoid space in doubtful, or suspicious, cases of CNS infection even in the presence of a normal ventricular CSF.

Key words:
Cerebrospinal fluid
Lumbar CSF
Ventricular CSF
Bacterial meningitis
Tuberculous meningitis hydrocephalus
Infectious hydrocephalus
Resumen
Antecedentes

El procedimiento habitual para el diagnóstico de infección del sistema nervioso central (CNS) consiste en el estudio del liquido cefalorraquídeo (LCR) mediante la realización de una punción lumbar. Sin embargo, en pacientes que debutan con un cuadro de hidrocefalia aguda que son tratados de urgencia mediante la inserción de un sistema de drenaje de LCR, el líquido es rutinariamente obtenido desde el sistema derivativo implantado. Pero, en ciertos casos, el LCR ventricular y lumbar analizados pueden mostrar diferencias significativas, tanto en condiciones fisiológicas como patológicas.

Casos ilustrativos

Se describen los casos de dos niños que presentaron resultados dispares en los estudios iniciales del LCR ventricular y lumbar, en los que se demostró posteriormente que padecían una hidrocefalia por meningitis tuberculosa, lo que motivó un considerable retraso en su diagnóstico y tratamiento.

Objetivo Al describir estos dos casos, pretendemos alertar al médico responsable sobre la posibilidad de esta discrepancia, para evitar retrasos en el diagnóstico y tratamiento de estos pacientes.

Discusión

Se comentan los posibles mecanismos patogénicos que pueden producir esta disociación en la composición del LCR ventricular y lumbar.

Conclusiones

Un resultado normal del LCR, especialmente del líquido ventricular, no descarta siempre la presencia de una meningitis tuberculosa. Sugerimos la obtención de una muestra de LCR a partir del espacio subaracnoideo lumbar en casos dudosos o sospechosos de infección del SNC, incluso ante la presencia de un LCR ventricular normal.

Palabras clave:
Liquido cefalorraquídeo
LCR lumbar
LCR ventricular
Meningitis bacterianas
Hidrocefalia en meningitis tuberculosa
Hidrocefalia postinfecciosa

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