Clinical Review Lesson of the week

Spectrophotometry of cerebrospinal fluid in suspected subarachnoid haemorrhage

BMJ 2005; 330 doi: (Published 13 January 2005) Cite this as: BMJ 2005;330:138
  1. Anne Cruickshank, consultant chemical pathologist (,
  2. Robert Beetham, consultant clinical scientist2,
  3. Ian Holbrook, consultant clinical scientist3,
  4. Ian Watson, consultant clinical scientist4,
  5. Philip Wenham, consultant clinical scientist5,
  6. Geoffrey Keir, consultant clinical scientist6,
  7. Peter White, deputy director UK NEQAS for immunology and immunochemistry7,
  8. William Egner, director7
  1. 1 Department of Biochemistry, Southern General Hospital, Glasgow G51 4TF,
  2. 2 Frenchay Hospital, Bristol,
  3. 3 York Hospital, York,
  4. 4 Walton Centre for Neurology and Neurosurgery, Liverpool,
  5. 5 Victoria Hospital, Kirckaldy,
  6. 6 Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, London,
  7. 7 Department of Immunology, Northern General Hospital, Sheffield
  1. Correspondence to: A Cruickshank
  • Accepted 25 September 2004


To underline the importance of correctly examining cerebrospinal fluid, we describe two patients with subarachnoid haemorrhage for whom cranial computerised tomography was normal and on whom lumbar puncture was subsequently done. Both had clear and colourless cerebrospinal fluid, but subsequent spectrophotometry showed bilirubin. Cerebral angiography then showed a ruptured aneurysm in each patient.

Case reports

Case 1A 28 year old woman presented with nausea and diplopia. She had global headache which had awoken her 14 days before. This was associated with neck pain and stiffness, vomiting for two days, and photophobia for five to six days. On examination, severe bilateral papilloedema, and signs of a VIth nerve palsy were present. Cranial computerised …

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