Milky cerebrospinal fluid and serum in hypertriglyceridemia

A 49-year-old man presented with sudden of change of consciousness and left hemiplegia. He had the history of diabetes mellitus, hypertension and hyperlipidemia; however, he did not receive regular medical treatment. Computed tomography (CT) of brain disclosed a 7.1 × 3.9 cm hemorrhagic lesion (CT number: 70 Hounsfield unit (HU)) in right basal ganglion with suspicious fatty density (CT number: −4 HU) in its peripheral portion and in the ventricles (Figure 1A). Emergent craniotomy and evacuation of intracerebral hematoma were performed. However, deterioration of consciousness developed next day, and repeated CT showed intraventricular hemorrhage with obstructive hydrocephalus. Therefore, emergent hematoma evacuation was done and external ventricle drain (EVD) was inserted. The drainage of cerebrospinal fluid (CSF) showed a milky color, which indicated the possibility of high triglycerides (Figure 1B). In addition, milky serum was noted, and the result of laboratory examinations revealed blood glucose of 289 mg/dl, total cholesterol of 1171 mg/dl, low-density lipoprotein of 197 mg/dl, high-density lipoprotein of 17 mg/dl and triglyceride of 13 611 mg/dl. The diagnosis of severe hypertriglyceridemia-related milky CSF was confirmed. Despite the aggressive supportive care, the patient died 5 days later.