A left occipital lobe hypodensity was noted, indicating a subacute stroke; analysis of the cerebrospinal fluid (CSF) showed a high protein level of 0.56 g/L, 4 neutrophils, normal glucose and xanthochromia. Culture of the CSF did not yield any bacterial growth.
Xanthochromia is a yellowish color change in the centrifuged CSF, which results from RBC hemolysis and is suggestive of, but not pathognomonic for, SAH.
Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis did not show any blood or xanthochromia. On his second hospital day, the patient developed an acute change in the mental status.
Cerebrospinal fluid (CSF) revealed the following: leucocytes 13/[mm.sup.3] with a lymphocytic predominance, erythrocytes 10/[mm.sup.3] without xanthochromia, normal protein and glucose, and negative Gram stain.
A lumbar puncture was done and revealed: no xanthochromia, 912 red blood cells (RBCs), 3 white blood cells (WBCs) with no polymorphonuclear cells, 43 mg/dL protein, and 87 ng/dL glucose (serum glucose 200 mg/dL), cerebrospinal fluid gram stain and culture were negative.
The results of the cerebral spinal fluid analysis were inconclusive; no malignant cells were found on cytology and there was no evidence of infection or xanthochromia.
If uncontrasted CT of the brain is negative, a lumbar puncture should be performed to establish the presence of xanthochromia, unless a contraindication to lumbar puncture is present.
Such dilation may also cause diapedesis of cells and proteins into the subarachnoid space, explaining the reticulocytes, xanthochromia, mononuclear pleocytosis and increased protein found in CSF from patients with SIH or ICH.17
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