Diagnostic utility of cerebrospinal fluid analysis in children presenting with acute neurological emergencies at a tertiary care hospital

Abstract

Background: Acute neurological emergencies include a wide range of conditions with variable and overlapping clinical presentations, making clinical diagnosis challenging. Advances in cerebrospinal fluid (CSF) analysis, serum antibody testing and neuroimaging have improved diagnostic accuracy. This study aimed to analyse the differentiating clinical, laboratory and neuroimaging features in children with various neurological emergencies. Methods: It was prospective observational study in children aged 1 month to 18 years between July 2022 and June 2024 presenting with acute neurological emergencies necessitating CSF analysis. Data were collected and analysed using IBM SPSS version 29. Results: Of the total (135), 37% were infants. CNS infections were most common (67; 49.6%), followed by demyelinating disorders (33; 24.4%), autoimmune encephalitis (7; 5.2%), metabolic encephalopathy (2; 1.5%) and other diagnoses (26; 19.3%). Bacterial meningitis (28.4%) and acute demyelinating encephalomyelitis (45.5%) were the most common conditions in their respective groups. Fever and lethargy predominated in CNS infections and demyelinating disorders. Key features in ADEM were difficulty in walking (45.5%) and acute onset weakness (45.5%). Altered sensorium (71.4%) and altered behaviour (42.9%) were predominant in autoimmune encephalitis. 93.3% ADEM and 87.5% optic neuritis were MOG (Myelin Oligodendrocyte Glycoprotein) antibody positive with MRI abnormalities (90.9%). 47% autoimmune encephalitis positive for anti-NMDAR (N-methyl-D-aspartate receptor) antibody with EEG (electroencephalogram) abnormalities (57.1%). Conclusions: Serum antibody testing aids in diagnosing demyelinating and autoimmune disorders, while CSF polymerase chain reaction (PCR) helps identifying pathogens in culture-negative CNS infections. CSF analysis has limited utility in noninfective conditions.