Lab

Cerebrospinal Fluid Examination

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Cerebrospinal Fluid Examination, CSF Exam, Cerebrospinal Fluid Abnormality

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