ELLIOT GOLDSTEIN, M.D.; M. J. WINSHIP, M.D.; DEMOSTHENES PAPPAGIANIS, M.D., Ph.D.
An Ommaya reservoir is often used to administer chemotherapy in the treatment of fungal meningitis. Since management of these chronic infections requires periodic analyses of cerebrospinal fluid, there is a tendency to obtain specimens from this site rather than from repeated lumbar taps. In three cases of meningitis due to Coccidioides immitis, one of which was complicated by a staphylococcal superinfection, analysis of ventricular fluid obtained from the reservoir was diagnostically misleading. This fluid usually showed protein concentrations of less than 30 mg/100 ml, glucose concentrations of more than 57 mg/100 ml, falsely low complement-fixing antibody titers, and small numbers of cells. Spinal fluid from the lumbar space showed the characteristic abnormalities associated with meningitis, in protein, glucose, and cellular constituents. This masking effect is caused by physiological differences between ventricular and lumbar fluid and can be great enough to limit the diagnostic value of ventricular fluid.
GOLDSTEIN E, WINSHIP MJ, PAPPAGIANIS D. Ventricular Fluid and the Management of Coccidioidal Meningitis. Ann Intern Med. 1972;77:243–246. doi: https://doi.org/10.7326/0003-4819-77-2-243
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Published: Ann Intern Med. 1972;77(2):243-246.
CNS Infections, Infectious Disease, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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