ABSTRACT
BACKGROUND: External ventricular drain (EVD)-associated ventriculitis is a serious complication. Early diagnosis can be difficult particularly in critically ill patients with aneurysmal subarachnoid hemorrhage (aSAH). We examined the diagnostic potential of standard serum and cerebrospinal fluid (CSF) biomarkers to differentiate between EVD-associated infections and aseptic courses in patients with aSAH. MATERIALS AND METHODS: We retrospectively evaluated the levels of inflammatory markers in serum (white blood cell count, percentage of neutrophils [sN%], and procalcitonin) and CSF (total leukocyte count [CSFTLC], CSFglucose, CSF/serumglucose ratio, CSF total protein [CSFTP]) of 63 consecutive patients with aSAH. Receiver operating characteristic curves and the area-under-the-curve (AUC) were calculated to detect the diagnostic potential, optimized threshold, sensitivity (SE), specificity (SP), + likelihood ratio (LR), and -LR of each biomarker. RESULTS: Of all patients, 17 (27%) developed an EVD-associated ventriculitis within a mean of 7.8±2.3 days after implantation. sN% had a very good diagnostic potential (AUC=0.900, SE=70.0%, SP=100%), followed by the CSFTLC with good diagnostic potential (AUC=0.841, SE=75.0%, SP=88.5%), and the CSFTP with moderate diagnostic potential (AUC=0.772, SE=73.3%, SP=76.0%). sN% higher than 70% and a CSFTLC higher than 635/µL were highly associated with the diagnosis of ventriculitis (+LR=∞ and 6.5), sN%<70% or a CSFTLC<635 made a diagnosis of ventriculitis unlikely (-LR=0.3 and 0.28). CONCLUSIONS: Routine determination of N% and CSFTLC are useful to distinguish ventriculitis from aseptic courses in the acute phase after aSAH and regardless of the bacteriological test result.
Subject(s)
Cerebral Ventricles , Cerebral Ventriculitis/blood , Cerebral Ventriculitis/cerebrospinal fluid , Drainage/adverse effects , Inflammation/metabolism , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/therapy , Aged , Area Under Curve , Biomarkers/blood , Biomarkers/cerebrospinal fluid , Blood Cell Count , Blood Glucose/analysis , Cerebral Ventriculitis/etiology , Critical Care , Early Diagnosis , Female , Glucose/cerebrospinal fluid , Humans , Inflammation/blood , Inflammation/cerebrospinal fluid , Leukocyte Count , Male , Middle Aged , Reproducibility of Results , Retrospective StudiesABSTRACT
BACKGROUND: Tumor markers are widely applied in clinical practice, however, few serum markers have been found for intracranial tumors. Herein, we firstly report an intracranial epidermoid cyst case with extremely high level of serum CA 199. Furthermore, the relationship between CA 199 level and intracranial epidermoid cyst was closely followed for a long period. CASE PRESENTATION: We report a case of 41-year-old man with a history of 2 months' headache and sudden exacerbation for 3 days. Radiology examination suggested multiple lesions spreading along ventricular system. Laboratory tests showed exceeding increase of serum CA 199. The patient underwent craniotomy and continuous lumber drainage. Post-operative pathology proved a ruptured intracranial epidermoid cyst. MRI scans and serum CA 199 were closely followed up for three years. CONCLUSION: This case suggests an important role of serum CA 199 in the diagnosis and follow-up of intracranial epidermoid cyst. Ruptured intracranial epidermoid cyst should be considered for a sudden onset case with multiple intracranial lesions and dramatically increased serum CA 199.
Subject(s)
Antigens, Tumor-Associated, Carbohydrate/blood , Brain Neoplasms , Cerebral Ventriculitis , Epidermal Cyst , Adult , Brain Neoplasms/blood , Brain Neoplasms/diagnosis , Brain Neoplasms/diagnostic imaging , Cerebral Ventriculitis/blood , Cerebral Ventriculitis/diagnosis , Cerebral Ventriculitis/diagnostic imaging , Epidermal Cyst/blood , Epidermal Cyst/diagnosis , Epidermal Cyst/diagnostic imaging , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Radiography , Rupture, SpontaneousABSTRACT
OBJECTIVES: Presence of residual blood is a common problem in cerebrospinal fluid (CSF) diagnostics of ventriculitis. We hypothesised that neutrophil granulocytes in infected, blood-containing CSF lose CD62L expression. Therefore CD62L expression on neutrophils may present a complementary marker to distinguish between patients with residual blood and infection. DESIGNS AND METHODS: Evaluation was performed in 64 ventricular CSF samples sent to the laboratory for diagnostic investigation. Cell count, microbiological culture, total protein and flow cytometric analysis of CSF were performed. RESULTS: Cell counts and CD62L expression were significantly different between the culture positive and negative group. ROC-analysis revealed a significant predictive value for cell count and CD62L expression. Optimal cut-offs were calculated and a decision tree was established to predict a positive culture. CONCLUSIONS: Cell count and CD62L expression were predictive for a positive culture and the combination helped to increase specificity and sensitivity for the detection of ventriculitis in blood-containing CSF.
