Lab
Cerebrospinal Fluid Examination
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Cerebrospinal Fluid Examination
, CSF Exam, Cerebrospinal Fluid Abnormality
See Also
Meningitis
Lumbar Puncture
Nigrovic Clinical Decision Rule
Findings
Normal
CSF Color
: Clear
CSF Glucose
Children and Adults: 50-80 mg/dl
Normal newborn: >60% of simultaneous
Serum Glucose
Normal infant: >50% of simultaneous
Serum Glucose
CSF Protein
Children and Adults: 20-45 mg/dl
Normal term newborn: <70 mg/dl
Normal term newborn: <40 mg/dl
CSF Chloride 116-122
CSF Opening Pressure
100-200
CSF Leukocyte
s
No
Neutrophil
s and under 6
Lymphocyte
s
Normal term newborn: <10 WBCs/ml (<10%
Neutrophil
s)
Findings
Bacterial Meningitis
See
Nigrovic Clinical Decision Rule
CSF Color
: Cloudy CSF
CSF Glucose
much less than 40% of
Serum Glucose
or 40 mg/dl (but normal in half of
Bacterial Meningitis
)
CSF Protein
>100 mg/dl
CSF Leukocyte
s: Markedly increased
Neutrophil
s
WBC >100/mm3 in 99% of cases and >1000/mm3 in most cases
CSF Opening Pressure
: increased >200
CSF Culture
positive in 70% of cases
Findings
Viral Meningitis
CSF Color
: Clear to Cloudy Fluid
CSF Glucose
: Normal
CSF Protein
> 45 (typically near normal)
CSF Leukocyte
s: Increased CSF
Lymphocyte
s
CSF Opening Pressure
: Normal or increased
Findings
Fungal
Meningitis
CSF Color
: Clear to Cloudy Fluid
CSF Glucose
< 50
CSF Protein
> 45
CSF Leukocyte
s:
Monocyte
s increased
CSF Opening Pressure
: Increased
Findings
Tuberculosis
Meningitis
CSF Color
: Cloudy Fluid
CSF Glucose
< 50
CSF Protein
> 45
CSF Leukocyte
s
Early:
Neutrophil
s increased
Later:
Lymphocyte
s increased
Findings
Intracranial Hemorrhage
CSF Color
: Bloody CSF with
Xanthochromia
CSF Glucose
: Normal or decreased
CSF Protein
: >45
CSF Red Blood Cell
s: Increased
CSF Opening Pressure
: Increased >200
Findings
Neoplasm
CSF Color
: Clear or xanthochromic
CSF Glucose
: Normal or decreased
CSF Protein
: Normal or increased
CSF Leukocyte
s: Normal or increased
Lymphocyte
s
CSF Opening Pressure
: Increased >200
Findings
Neuro-
Syphilis
CSF Color
: Clear to cloudy fluid
CSF Glucose
: Normal
CSF Protein
: >45
CSF Leukocyte
s:
Monocyte
s increased
CSF Opening Pressure
: Normal or increased
Findings
Guillain-Barre
CSF Color
: Clear to cloudy fluid
CSF Glucose
: Normal
CSF Protein
much greater than 45
CSF Leukocyte
s:
Lymphocyte
s normal or increased
CSF Opening Pressure
: Normal
References
Kooiker in Roberts (1998) Procedures in ER, p. 1067-75
Ravel (1995) Lab Medicine, Mosby, p. 294-9
Tunkel in Mandell (2000) Infectious Disease, p. 974-8
Griffith (1994) Neurol Clin 12:541-64 [PubMed]
Mount (2017) Am Fam Physician 96(5): 314-22 [PubMed]
Seehusen (2003) Am Fam Physician 68:1103-8 [PubMed]
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