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, data terbaru 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 di otak karena trauma maupun penyebab nontrauma. Sekitar 85% perdarahan subarachnoid nontrauma disebabkan oleh ruptur aneurisma. Gejala utama dari perdarahan subarachnoid adalah sakit kepala hebat yang mencapai intensitas maksimal dalam 60 detik (thunderclap headache) dan gejala lainnya 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

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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.
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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.
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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.