Rapid Differential Diagnosis between Subarachnoid Hemorrhage and Traumatic Lumbar Puncture by D-Dimer Assay

Subarachnoid hemorrhage (SAH) and traumatic lumbar puncture (TLP) are both associated with blood-tinged cerebrospinal fluid (CSF). It is often difficult if not impossible to distinguish between SAH and TLP (1)(2) by available CSF tests such as ( a ) measurement of xanthochromia of the supernatant after centrifugation, ( b ) counting of erythrocytes in the first and last tubes of collected CSF, or ( c ) searching of CSF microscopically for crenated erythrocytes (3)(4)(5). We investigated the measurement of D-dimer (DD) in CSF and evaluated DD measurement as a means to distinguish between SAH and TLP. We measured DD in CSF with the coagulation analyzer STA Compact ® by the immunoturbidimetric assay, STA Liatest D-DI® (Roche Diagnostics). Erythrocyte counts were performed by optical microscopy with a Fuchs-Rosenthal …