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Normal ventricular-CSF may confound the diagnosis of tuberculous meningitis hydrocephalus

机译：正常脑室-脑脊液可能会混淆结核性脑膜炎脑积水的诊断

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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.
机译：背景。诊断中枢神经系统（CNS）感染的标准程序包括脑脊液（CSF）采样，通常通过腰椎穿刺完成。但是，在一些患有急性脑积水的患者中，需要立即进行CSF引流，通常是从放置的引流系统中获取液体。此外，在某些情况下，从心室和腰椎间隙获得的脑脊液在生理和病理状况上可能显示出不同寻常的差异。说明性案例。我们报告了两名儿童，他们的心室和腰部CSF的初步研究结果令人困惑，随后被诊断为结核性脑膜炎，导致诊断和治疗延迟。目标。通过报告这些病例，我们想提醒主治医师这种差异的可能性，以避免延迟诊断和治疗受影响的患者。讨论。我们评论可能导致这种分离的心室和腰部脑脊液成分的可能的病理生理机制。结论。脑脊液研究的正常结果，尤其是脑室液的研究，并不总是排除结核性脑膜炎的存在。我们建议从可疑或可疑的中枢神经系统感染病例中，从腰蛛网膜下腔获得脑脊液样本，即使存在正常的心室脑脊液也是如此。

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