Published Online
on May 5, 2005

A more recent version of this article appeared on June 1, 2005

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Submitted on January 7, 2005
Accepted on February 25, 2005

Why Human Color Vision Cannot Reliably Detect Cerebrospinal Fluid Xanthochromia

Axel Petzold MD, PhD^*; Geoffrey Keir PhD, MSc FRCPath FIBMS; and Ted L. Sharpe PhD, MA

From the Tavistock Intensive Care Unit (A.P.), The National Hospital for Neurology and Neurosurgery, and Department of Neuroimmunology, Institute of Neurology, Queen Square, London, UK; the Department of Neuroimmunology (G.K.), Institute of Neurology, Queen Square, London, UK; and the Colour and Vision Research Laboratories (T.L.S.; http://cvrl.ioo.ucl.ac.uk/index.htm), Institute of Ophthalmology, London, UK.

^* To whom correspondence should be addressed. E-mail: a.petzold{at}ion.ucl.ac.uk.

Background--Visual assessment of cerebrospinal fluid (CSF) for xanthochromia (yellow color) is practiced by the majority of laboratories worldwide as a means of diagnosing intracranical bleeds.

Methods--Colorimetric and spectrophotometric analysis of CSF samples for recognizing the presence of bilirubin either in low concentrations or in the presence of hemolysed blood.

Results--The experiments provide the physiological and colorimetric basis for abandoning visual assessment of CSF for xanthochromia.

Conclusion--We strongly recommend relying on spectrophotometry as the analytical method of choice.

Key words: cerebrospinal fluid • intracerebral hemorrhage • subarachnoid hemorrhage

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