Summary about Disease
Xanthochromia refers to the yellowish or pinkish discoloration of cerebrospinal fluid (CSF). It indicates that there has been bleeding into the subarachnoid space or a breakdown of red blood cells in the CSF. It is not a disease in itself, but a sign of an underlying condition.
Symptoms
Xanthochromia is a sign detected in CSF analysis, not a symptom experienced by the patient directly. The symptoms a patient exhibits are related to the underlying cause of the xanthochromia (e.g., subarachnoid hemorrhage, meningitis, etc.). These symptoms can include:
Severe headache
Stiff neck
Fever
Photophobia (sensitivity to light)
Nausea and vomiting
Seizures
Altered mental status
Focal neurological deficits (weakness, numbness)
Causes
Xanthochromia can be caused by:
Subarachnoid Hemorrhage (SAH): Bleeding into the space between the brain and the surrounding membrane (arachnoid).
Intracerebral Hemorrhage: Bleeding within the brain tissue itself, which may eventually leak into the CSF.
Traumatic Lumbar Puncture: A "traumatic tap" during a lumbar puncture can introduce blood into the CSF sample. This must be differentiated from true xanthochromia.
Spinal Tumors: Some spinal tumors can cause bleeding into the CSF.
Meningitis: Inflammation of the meninges can sometimes lead to xanthochromia.
Elevated Bilirubin: In rare cases, very high levels of bilirubin in the blood (e.g., in severe liver disease) can cause CSF discoloration.
Elevated Protein: Very high CSF protein levels can sometimes mimic xanthochromia.
Medicine Used
4. Medicine used There is no medicine used specifically to treat xanthochromia itself. Treatment is directed towards addressing the underlying cause. For example:
Subarachnoid Hemorrhage: Medications to lower blood pressure, prevent vasospasm (e.g., nimodipine), and pain management. Surgery (clipping or coiling of aneurysm) may be necessary.
Meningitis: Antibiotics (for bacterial meningitis), antivirals (for viral meningitis), or antifungals (for fungal meningitis).
Spinal Tumors: Surgery, radiation therapy, or chemotherapy.
Is Communicable
Xanthochromia itself is not communicable. However, if the underlying cause is an infectious disease (e.g., bacterial meningitis), that disease is communicable.
Precautions
Precautions depend entirely on the underlying cause. If the cause is infectious meningitis, standard precautions (hand hygiene, mask) and droplet precautions are necessary to prevent the spread of the infection. For non-communicable causes (e.g., SAH), precautions are focused on patient safety and preventing complications.
How long does an outbreak last?
Xanthochromia isn't an outbreak, it's a diagnostic finding. The duration of xanthochromia depends on the underlying cause and its treatment. Xanthochromia caused by subarachnoid hemorrhage, for instance, can persist in the CSF for up to 2-4 weeks.
How is it diagnosed?
Xanthochromia is diagnosed through a lumbar puncture (spinal tap) and analysis of the cerebrospinal fluid (CSF). The CSF sample is visually inspected for color. Spectrophotometry is the gold standard method. It measures the absorbance of light at different wavelengths to detect the presence of oxyhemoglobin (bright pink) and bilirubin (yellowish-orange), the substances responsible for xanthochromia.
Timeline of Symptoms
The timeline of symptoms varies greatly depending on the underlying cause.
Subarachnoid Hemorrhage: Sudden onset of severe headache, often described as "the worst headache of my life."
Meningitis: Rapid onset of fever, headache, stiff neck, and photophobia.
Spinal Tumor: Gradual onset of pain, weakness, and sensory changes. Xanthochromia appears in the CSF within a few hours after subarachnoid hemorrhage or red blood cell breakdown. It can persist for several days to weeks.
Important Considerations
Traumatic Tap: It's crucial to differentiate true xanthochromia from a traumatic tap during lumbar puncture. In a traumatic tap, the blood will gradually clear as more CSF is collected. Centrifugation will show a clear supernatant in a traumatic tap, unlike xanthochromia.
Delay in Lumbar Puncture: If a lumbar puncture is delayed (e.g., more than 12 hours after a suspected SAH), xanthochromia becomes a more reliable indicator of hemorrhage.
False Positives/Negatives: While spectrophotometry is the most sensitive method, false positives can occur with high protein levels. False negatives are possible if the hemorrhage is small or occurred very recently.
Underlying Cause: Xanthochromia is a sign, not a diagnosis. Determining the underlying cause is paramount for appropriate management.