Abstract Details

Title Comparison of Lumbar and Ventricular Cerebrospinal Fluid for Diagnosis and Monitoring of Meningitis

Topic Infectious Disease

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-012

Objective To determine the difference between Cerebrospinal Fluid (CSF) obtained through lumbar puncture (LP) and external ventricular drain (EVD) in diagnosis and monitoring of meningitis.

Background Severe meningitis, especially basilar meningitis can lead to hydrocephalus requiring EVD placement. The difference in CSF obtained from EVD compared to LP for diagnosis and monitoring of meningitis have not been well documented.

Design/Methods Case series of six patients with meningitis leading to hydrocephalus and EVD placement.

Results Four patients with bacterial and two with fungal meningitis were included in the study. In all six patients, CSF from LP was obtained before EVD placement by 1.7 days. Although corrected White blood cell (WBC) counts were elevated in CSF obtained from LP and EVD, the counts were significantly higher through LP than EVD. The average WBC count in CSF from LP was 4711 per microliter and 191 per microliter in CSF from EVD. Protein concentration in CSF obtained from LP was also significantly higher than EVD. Average protein concentration in CSF obtained from LP was 462 milligram per deciliter and 39 milligram per deciliter in CSF from EVD. Glucose and red blood cells varied in both LP and EVD samples. Interestingly cultures in both fungal meningitis patients were positive in CSF obtained from EVD and not from LP.

Conclusions Although CSF was obtained from EVD later in the clinical course than LP, slower circulation of CSF in lumbar space as compared to ventricles is likely the reason for a more sterile appearance of CSF obtained from EVD compared to LP for diagnosis of meningitis. It is important to recognize this difference as CSF analysis from EVD for diagnosis of meningitis may lead to missed diagnosis, and false perception of significant improvement when monitoring response to treatment. Larger studies are needed to confirm the above findings.

Authors/Disclosures
Bhavika Kakadia, DO PRESENTER	Dr. Kakadia has nothing to disclose.
	No disclosure on file
	No disclosure on file
Tapan R. Kavi, MD	No disclosure on file

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