Contents

Search

cerebrospinal fluid analysis

Routine CSF analysis: 1) Cell count* with differential* 2) Gram stain 3) Bacterial cultures 4) CSF glucose & serum glucose 5) CSF protein# 6) CSF VDRL 7) CSF xanthochromia (presence) * 0-5 cells/uL (0 to 14-30 cells/uL neonates) [4,5] lymphocytes 62% +/- 34% monocytes 36% +/- 20% neutrophils 2% +/- 5% # CSF protein concentration increases as it passes from the ventricles to lumbar spine [3] ventricular CSF 5-15 mg/dL (total protein) cisternal CSF 15-25 mg/dL lumbar CSF 15-45 mg/dL Other CSF analyses depending upon clinical presentation 1) mycobacterial & fungal stains 2) mycobacterial cultures 3) serology for coccidioidomycosis 4) bacterial, viral, fungal antigens 5) multiple sclerosis panel a) need serum & CSF b) serum & CSF protein electrophoresis c) antibody to myelin basic protein 6) cytology 7) tumor markers - paraneoplastic antibody in CSF Tube # 1: protein, glucose Tube # 2: gram stain Tube # 3: cell count Tube # 4: saved for special studies CSF pressure: 10-15 cm H2O CSF appearance: clear, colorless CSF glucose: 40-70 mg/dL (60-70% of peripheral blood glucose) CSF protein 15-45 mg/dL CSF cell count: < 5 mononuclear leukocytes/mm3 CSF pressure: 1) increased in bacterial, tuberculis or fungal meningitis 2) may be increased or normal in viral meningitis 3) increased in subarachnoid hemorrhage 4) increased in meningeal carcinomatosis 5) increased in Pseudotumor cerebri 6) normal or increased in Guillain Barre syndrome 7) normal in multiple sclerosis CSF appearance: 1) cloudy in bacterial meningitis 2) clear, maybe cloudy in tuberculis or fungal meningitis 3) clear in viral meningitis 4) clear in meningeal carcinomatosis 5) bloody with xanthochromic supernatant in subarachnoid hemorrhage 6) bloody with clear supernatant in traumatic tap - RBC count <2000 106/L & no xanthochromia distinguishes traumatic tap from subarachnoid hemorrhage [8] 7) clear in multiple sclerosis 8) clear or xanthochromic in Guillain Barre syndrome 9) clear in pseudotumor cerebri CSF glucose: 1) decreased in bacterial meningitis, tuberculous meningitis - may be normal with listeriosis [6,7] 2) normal or decreased in tuberculous or fungal meningitis 3) normal in viral meningitis 4) normal or decreased in meningeal carcinomatosis 5) normal in paraneoplastic limbic encephalitis 6) normal in subarachnoid hemorrhage 7) normal in multiple sclerosis or Guillain Barre 8) normal in pseudotumor cerebri CSF protein: 1) increased in bacterial, tuberculous & fungal meningitis 2) normal or increased in viral meningitis 3) normal or increased in meningeal carcinomatosis 4) increased in subarachnoid hemorrhage 5) increased in traumatic tap 6) normal or increased in multiple sclerosis 7) very increased in Guillain Barre syndrome 8) normal in pseudotumor cerebri CSF cell count: 1) 500-10,000/mm3 with predominance of neutrophils in bacterial meningitis - listeriosis may present with either neutrophil or lymphocyte predominance with cell counts of 10-500/mm3 [6,7] 2) 10-500/mm3 with predominance of lymphocytes in tuberculous or fungal meningitis 3) > 6 lymphocytes/mm3 in viral meningitis 4) 10-500/mm3 with predominance of lymphocytes in meningeal carcinomatosis or paraneoplastic limbic encephalitis 5) 1000-3,500,000/mm3 RBCs with RBC:WBC ratio higher than peripheral blood in subarachnoid hemorrhage 6) fewer RBC in collection tube 4 than collection tube 1 intraumatic tap 7) 0-20 lymphocytes/mm3 in multiple sclerosis 8) < 5 mononuclear cells/mm3 (normal pattern) in Guillain-Barre & pseudotumor cerebri Notes: - if CSF leukocytosis & viral markers negative, consider paraneoplastic limbic encephalitis if malignancy identified vs acid fast stain & culture

Related

reference values for CSF constituents

Specific

CSF cell count CSF volume hemoglobin in CSF

General

chemistry panel hematology panel microbiology panel

References

  1. Fundamentals of Clinical Chemistry 3rd ed., N.W. Teitz ed., W.B. Saunders, 1988, pg 339
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1065-67
  3. Tietz Textbook of Clinical Chemistry, 2nd ed. Burtis CA & Ashwood ER (eds), WB Saunders Co, Philadelphia PA, 1993
  4. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996
  5. Byington CL et al. Normative cerebrospinal fluid profiles in febrile infants. J Pediatr 2011 Jan; 158:130. PMID: 20801462
  6. Bhimraj A. Acute community-acquired bacterial meningitis in adults: an evidence-based review. Cleve Clin J Med 2012 Jun 5; 79:393 PMID: 22660870
  7. Lorber B Community-acquired Listeria monocytogenes meningitis in adults. Clin Infect Dis. 2007 Mar 1;44(5):765-6. No abstract available. PMID: 17278080 Lorber B. - Listeriosis. Clin Infect Dis. 1997 Jan;24(1):1-9; quiz 10-1. PMID: 8994747
  8. Perry JJ et al. Differentiation between traumatic tap and aneurysmal subarachnoid hemorrhage: Prospective cohort study. BMJ 2015 Feb 18; 350:h568 PMID: 25694274 http://www.bmj.com/content/350/bmj.h568
  9. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018

Components

bacterial culture CSF cell count CSF gram stain CSF Xanthochromia glucose in CSF glucose in serum/plasma protein in cerebrospinal fluid (CSF) VDRL reagin slide CSF (CSF VDRL)