RESUMO
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.
Assuntos
Líquido Cefalorraquidiano , Hidrocefalia , Tuberculose Meníngea/líquido cefalorraquidiano , Tuberculose Meníngea/complicações , Tuberculose Meníngea/diagnóstico , Líquido Cefalorraquidiano/química , Líquido Cefalorraquidiano/microbiologia , Feminino , Humanos , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Lactente , Masculino , Punção Espinal , Tomografia Computadorizada por Raios X , Tuberculose Meníngea/microbiologiaRESUMO
Background. The standard procedure for the diagnosisof central nervous system (CNS) infections consistsof cerebrospinal fluid (CSF) sampling, which isusually accomplished by a lumbar puncture. However,in some patients presenting with acute hydrocephalussubmitted to immediate CSF drainage, the fluid is customarilyobtained from the placed draining system.In addition, the CSF obtained from the ventricularand lumbar spaces in some cases may show unusualdifferences, both in physiological and pathologicalconditions.Illustrative cases. We report two children who presentedwith confounding results in the initial studiesof their ventricular and lumbar CSF who were subsequentlydiagnosed with tuberculous meningitis, causingdelay in diagnosis and treatment.Aim. By reporting these cases, we wanted to alert thetreating physician about the possibility of this discrepancyto avoid the delayed diagnosis and management (..) (AU)
Antecedentes. El procedimiento habitual para eldiagnóstico 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 cuadrode hidrocefalia aguda que son tratados de urgenciamediante la inserción de un sistema de drenaje deLCR, el líquido es rutinariamente obtenido desde elsistema derivativo implantado. Pero, en ciertos casos,el LCR ventricular y lumbar analizados pueden mostrardiferencias significativas, tanto en condicionesfisiológicas como patológicas.Casos ilustrativos. Se describen los casos de dosniños que presentaron resultados dispares en losestudios iniciales del LCR ventricular y lumbar, enlos que se demostró posteriormente que padecíanuna hidrocefalia por meningitis tuberculosa, lo que (..) (AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Tuberculose Meníngea/complicações , Hidrocefalia/líquido cefalorraquidiano , Líquido Cefalorraquidiano/citologia , Tomografia Computadorizada por Raios XRESUMO
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