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May 3, 1985

Identification of Xanthochromia

JAMA. 1985;253(17):2496. doi:10.1001/jama.1985.03350410042017

To the Editor.—  This is in reference to the letter entitled "Identification of Xanthochromia" by Dr Fisher.1 He recommends inspecting the cerebrospinal fluid (CSF) tube in front of an x-ray view box. There is another simple way to inspect the CSF visually at the beside for xanthochromia or pleocytosis (especially if the lumbar puncture is nontraumatic). Instead of looking horizontally through the tube, the physician should unscrew the cap and look vertically down through the tube, using a white background. By using the tube that has the most CSF, the physician can easily identify faint xanthochromia or pleocytosis. I have found this method of CSF examination superior to that suggested by Dr Fisher.In reviewing the literature,2,3 and several neurology texts,4-6I found that only two books5,6 briefly mention inspecting the CSF this way.