Pungsi Lumbal untuk Diagnosis Perdarahan Subarachnoid: Masihkah Diperlukan?

Oleh :

dr. Ade Wijaya SpN

Pungsi lumbal selama ini dilakukan untuk mendiagnosis pasien suspek perdarahan subarachnoid yang memiliki gambaran computed tomography (CT) otak normal. Hal ini dilakukan untuk menghindari false negative. Namun, beberapa studi menunjukkan bahwa hasil CT scan otak yang dilakukan dalam rentang waktu 6 jam sejak onset memiliki sensitivitas sangat tinggi sehingga pungsi lumbal mungkin tidak diperlukan.[1]

Perdarahan subarachnoid merupakan salah satu perdarahan intrakranial yang terjadi akibat pecahnya pembuluh darah otak karena trauma dan nontrauma. Sekitar 85% perdarahan subarachnoid nontrauma disebabkan ruptur aneurisma. Gejala utama adalah sakit kepala hebat yang mencapai intensitas maksimal dalam 60 detik (thunderclap headache). Gejala lain dapat berupa kaku kuduk, kejang, penurunan kesadaran, dan defisit neurologis fokal.[1-3]

Diagnosis Perdarahan Subarachnoid

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA. Sensitivity of early brain computed tomography to exclude aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Stroke. 2016;47(3):750-5.
2. Lantigua H, Ortega-Gutierrez S, Schmidt JM, et al. Subarachnoid hemorrhage: who dies, and why? Critical Care. 2015;19(1):309.
3. Suarez Jl, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354940:387-96.
4. Gorchynski J. Interpretation of traumatic lumbar punctures in the setting of possible subarachnoid hemorrhage: who can be safely discharged? Cal J Emerg Med. 2007;8:3-7.
5. Perry JJ, Sivilotti ML, Émond M, et al. Prospective implementation of the ottawa subarachnoid hemorrhage rule and 6-hour computed tomography rule. Stroke. 2020;51(2):424-430.
6. Steffens S, Tucker P, Evans DD. Acute headache in the emergency department: is lumbar puncture still necessary to rule out subarachnoid hemorrhage? Advanced Emergency Nursing Journal. 2018;40(2):78-86.
7. Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous subarachnoid hemorrhage: a systematic review and meta‐analysis describing the diagnostic accuracy of history, physical examination, imaging, and lumbar puncture with an exploration of test thresholds. Academic Emergency Medicine. 2016;23(9):963-1003.
8. Taylor RA, Singh GH, Marcolini EG, et al. Determination of a testing threshold for lumbar puncture in the diagnosis of subarachnoid hemorrhage after a negative head computed tomography: a decision analysis. Academic Emergency Medicine. 2016;23(10):1119-27.
9. Tulla M, Tillgren T, Mattila K. Is there a role for lumbar puncture in early detection of subarachnoid hemorrhage after negative head CT? Internal and Emergency Medicine. 2019;14(3):451-7.
10. Valle JA, Fonseca FD, Vaquero MÁ, et al. Sudden headache, lumbar puncture, and the diagnosis of subarachnoid hemorrhage in patients with normal computed tomography scans. Emergencias. 2018;30(1):50-3.
11. Perry JJ, Stiell IG, Sivilotti ML, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013;310(12):1248-55.
12. Perry JJ, Eagles D, Clement CM, et al. An international study of emergency physicians’ practice for acute headache management and the need for a clinical decision rule. CJEM. 2009;11:516–22.
13. Newman D. Risk assessment: high-risk headache in the emergency department. The NNT. 2010.