Cerebrospinal fluid syndromes in HIV-positive patients with acute consciousness compromise

Revisamos as síndromes liquóricas de 100 pacientes HIV-positivos apresentando comprometimento agudo da consciência em pronto-socorro, as correlacionando com dados clínicos. As síndromes mais freqüentes foram: dissociaçäo proteino-citológica absoluta (21), viral (19), neurocriptococose (7), dissociaçäo proteino-citológica relativa (6) e séptica (4), hipoglicorraquia moderada (4 por cento), hipoglicorraquia severa (4 por cento), distúrbio hidroeletrolítico (3 por cento). Um quinto dos pacientes apresentou síndromes liquóricas consideradas suficientes para um diagnóstico ou uma conduta imediata. Os dados clínicos mais comuns foram infecciosos e neurológicos. Houve pouca correlaçäo entre os dados clínicos e as síndromes liquóricas. Comparado a dados de literatura, HIV-positivos tem menor chance de resultados decisivos no exame de líquor. Nós concluimos que, em pacientes HIV-positivos, que se apresentam com alteraçöes agudas da consciência, freqüentemente há resultados inespecíficos no líquor, o que deve ser julgado em funçäo de uma história clínica e exame físicos detalhados

Cerebrospinal fluid syndromes in patients with acute consciousness compromise

We reviewed the laboratory cards of 200 analysis of cerebrospinal fluid (CSF) performed to evaluate acute alterations of consciousness in adult patients attended in a neurological emergency room. 61 percent were men; the mean age was 46 years. The most common clinical data were infective and neurologic. The CSF was abnormal in 149 (74.5 percent) patients and the most common syndromes were: compressive (21 percent), hemorrhagic (11.5 percent), "viral"(8.5 percent), septic (7.5 percent), moderate hyperglycorrachia (6.5 percent), hidroelectrolytic disturbances (5.5 percent). There were some statistically significant correlations between CSF syndromes and clinical data: septic syndrome and fever and meningeal signs, hemorrhagic syndrome and headache and meningeal signs, CSF hydroelectrolytic disturbance syndrome and seizure, severe hyperproteinorrchia and headache, fever, meningeal signs and vomiting, moderate hyperproteinorrachia and age over 65 and male sex. We classified the abnormal results in two groups: 1 - sufficient for an immediate clinical decision; 2 - nonspecific. The former group was found in 27.5 percent of the patients and in 36.9 percent of the abnormal CSF results. In patients attending to neurologic emergency rooms with acute alterations of consciousness, the ecamination of the CSF frequently could contribute to an etiologic diagnosis. It must be performed after a rigorous clinical evaluation of the patient.