CSF: How certain can we be?. Meira Louis PGY1. Objectives. Present a published case highlighting the difficulties in CSF diagnosis Understand the objective evidence for the tests ordered on CSF Understand where clinical judgement falls in the spectrum of certainty. Sheila. PMX:
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1 day history:
Huynh et al, 2007
Thomson et al, 2001.; Van de Beek, 2004.
Predicted WBC = CSF RBC x serum WBC
Mayefsky et al. 1987
What’s the sensitivity for bacteria?
All common etiologies-no previous antibiotics 75-90%
All common etiologies-antimicrobial therapy prior to LP 40-60%
Streptococcus pneumoniae 90%
Neisseria meningitidis 75%
Haemophilus influenzae 86%
Listeria monocytogenes <50%
Gram-negative bacilli 50%
Gray et al, 1992
Ray et al, 2006