How to Differentiate Traumatic Lumbar Punctures from Aneurysmal Subarachnoid Hemorrhage

The combination of a red blood cell count less than 2000 × 10⁶/L and no xanthochromia is sufficient to rule out aneurysmal SAH in patients with traumatic lumbar punctures.

The diagnosis of subarachnoid hemorrhage (SAH) often requires lumbar puncture (NEJM JW Emerg Med Mar 2013 and Ann Emerg Med 2013; 62:1), however, in an estimated 10% to 30% of procedures that are traumatic, iatrogenic bleeding can complicate diagnosis. To identify cerebrospinal fluid characteristics that might differentiate between SAH and traumatic lumbar puncture, researchers conducted a planned substudy of a prospective multicenter study. They enrolled 1739 alert (Glasgow Coma Scale score, 15) patients older than 15 years with acute nontraumatic headache who underwent lumbar puncture to rule out SAH. Presence of aneurysmal SAH was determined by computed tomography (CT), CT angiography, or follow-up by phone at 1 and 6 months for patients…

Reviewing Author

Ali S. Raja, MD, MBA, MPH, FACEP

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

Ali S. Raja, MD, MBA, MPH, FACEP

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

How to Differentiate Traumatic Lumbar Punctures from Aneurysmal Subarachnoid Hemorrhage

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Reviewing Author