Gross xanthochromia on lumbar puncture may not represent an acute subarachnoid hemorrhage.

Headache is a common presenting complaint in the emergency department (ED) that sometimes requires a diagnostic workup including a lumbar puncture (LP). An LP is often used to evaluate patients in the ED for an acute neurologic process. Xanthochromia seen on cerebrospinal fluid from an LP is often considered to be highly suggestive of a subarachnoid hemorrhage. We describe 2 cases where gross xanthochromia was noted during LP but the patients did not have an acute subarachnoid hemorrhage.