A middle aged female recently seen in ED x 2 for chest wall pain, presents with one day of bilateral hearing loss, headache, and vomiting. She was initially afebrile but subsequently developed a mild fever. We discussed a broad differential including SAH and infection; she was ultimately diagnosed with strep agalactie (GBS) meningitis based on blood cultures and results of an LP!
Interpreting an LP with many RBCs:
– How many WBCs is too many?
*Here is a nifty calculator to help you adjust your WBCs for a suspected traumatic tap
-How can we distinguish SAH from traumatic tap?
*Clearing of RBCs from tubes 1 to 4 is helpful in excluding SAH ONLY if there are substantial RBCs in tube 1 and none in tube 4
*A Xanthrochromic supernatant is very suggestive of SAH