CSF

INVESTIGATIO
N
BY
DR DEEPTI PATIL
DEPT. OF DRAVYAGUNA
 INTRODUCTION

Cerebrospinal fluid (CSF) analysis is a set of

laboratory tests that examine a sample of the
fluid surrounding the brain and spinal cord.

CSF is an ultra filtrate of plasma.

It is clear and colorless.

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 Conti…
It contains glucose, electrolytes, amino
acids, and other small molecules found
in plasma

CSF protects the central nervous

system from injury,

Provides nutrients, and removes waste

products by returning them to the
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 ALTERNATE NAMES
Spinal tap;

Ventricular puncture;

Lumbar puncture;

Cisternal puncture;

Cerebral spinal fluid culture

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 CONDITIONS TO
INVESTIGATE
1. Chronic 6. Generalized tonic-
inflammatory clonic seizure
polyneuropathy
7. Hydrocephalus
Dementia due to
Inhalation anthrax
2.
8.

metabolic causes
9. Normal pressure
Encephalitis
hydrocephalus
3.

4. Epilepsy (NPH)
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 NORMAL VALUES
Gross appearance: Clear and Colorless.

CSF opening pressure: 50–175 mm H 2

O.

Specific gravity: 1.006–1.009.

Glucose: 40–80 mg/dL.

Total protein: 15–45 mg/dL.

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 Conti…
Leukocytes (white blood cells): 0–
5/microL (adults and children); up to
30/microL (newborns).

Differential: 60–80% lymphocytes; up

to 30% monocytes and macrophages;
other cells 2% or less. Monocytes and
macrophages are somewhat higher in
neonates.
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 Conti…
Chloride: 110 - 125 mEq/L

Gram stain: negative.

Lactate: less than 35 mg/dL.

Red blood cell count: No red blood cells

in CSF

LD: 1/10 of serum level.

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 TEST PROCEDURE
The patient lies on his or her side, with
knees pulled up toward the chest, and
chin tucked downward.

After the back is cleaned, the health care

provider will inject a local numbing
medicine (anesthetic) into the lower
spine.

A spinal needle CSF

4/8/11 is INVESTIGATION
inserted, usually into 99
 Conti…
Once the needle is properly positioned,
CSF pressure is measured and a
sample is collected.

The needle is removed, the area is

cleaned, and a bandage is placed over
the needle site. The person is often
asked to lie down for a short time after
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the test.
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 POST OPERATIVE CARE
Site of the puncture is covered with a
sterile bandage.
The patient should remain lying down
for four to six hours after the lumbar
puncture.

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 Conti…
Vital signs should be monitored every
15 minutes for four hours, then every
30 minutes for another four hours.

The puncture site should be observed

for signs of weeping or swelling for 24
hours.

The neurological status of the patient

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should be evaluated
 RISK
Bleeding into the spinal canal

Discomfort during the test

Headache after the test occurs in 10–30% of

adult patients and in up to 40% of children

Hypersensitivity (allergic) reaction to the

anesthetic

Infection introduced by the needle going

through
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the skin CSF INVESTIGATION 1515
 PURPOSE

To measure pressures within the

cerebrospinal fluid and

To collect a sample of the fluid for

further testing.

CSF analysis is used to diagnose

certain neurologic disorders,
particularly
4/8/11 infections (such as
CSF INVESTIGATION 1616
 CONSIDERATIONS

This test is dangerous for people with:

A tumor in the back of the brain that is

pressing down on the brain stem

Blood clotting problems

Thrombocytopenia

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 ABNORMAL CSF COLOUR

Cloudy CSF:- Infection or a build up of

white blood cells or protein.

Bloody or red CSF:- Bleeding or spinal

cord obstruction.

Brown, Orange, or Yellow:- sign of

increased CSF protein or previous
bleeding
4/8/11 (moreCSFthan 3 days ago).
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 CSF PRESSURE

Increased CSF pressure:- Increased

intracranial pressure (pressure within the
skull).

Decreased CSF pressure:- spinal cord tumor,

shock, fainting, or diabetic coma.

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 PROTEINS

Increased CSF protein:- Blood in the CSF,

diabetes, polyneuritis, tumor, injury, or any
inflammatory or infectious condition.

Decreased protein is a sign of rapid CSF

production.

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 CSF Gamma Globulin

Increased CSF gamma globulin levels

may be due to diseases such as

§ Multiple sclerosis
§ Neurosyphilis, or
§ Guillain-barre syndrome

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 CSF Glucose

Increased CSF glucose:- Sign of high

blood sugar.

Decreased CSF glucose:-

Hypoglycemia (low blood sugar),
bacterial or fungal infection (such as
meningitis), tuberculosis, or certain
other
4/8/11
types of CSF
meningitis.
INVESTIGATION 2222
 White Blood Cells

Increased white blood cells in CSF:-

Sign of meningitis, acute infection,

beginning of a chronic illness, tumor,

abscess,

stroke, or demyelinating disease (such

as
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 RED BLOOD CELLS

Red blood cells in the CSF sample may

be a sign of bleeding into the spinal
fluid

Traumatic lumbar puncture.

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 LACTATE DEHYDROGENASE

This enzyme is elevated in

bacterial and fungal meningitis,
malignancy, and subarachnoid
hemorrhage.

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 GRAM STAIN

The Gram stain is performed on a

sediment of the CSF

Positive in at least 60 percent of cases

of bacterial meningitis.

Culture is performed for both aerobic

and anaerobic bacteria.
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 Average and Range of Cerebrospinal Fluid
Average: mg per dL (g Range: mg per dL (g
Condition per L) Protein per L)
Bacterial meningitis 418 (4.18) 21 to 2220 (0.21 to 22.2)

Brain tumor 115 (1.15) 15 to 1920 (0.15 to 19.2)

Brain abscess 69 (0.69) 16 to 288 (0.16 to 2.88)

Aseptic meningitis 77 (0.77) 11 to 400 (0.11 to 4.0)
Multiple sclerosis 43 (0.43) 13 to 133 (0.13 to 1.33)
Cerebral hemorrhage 270 (2.7) 19 to 2110 (0.19 to 21.1)

Epilepsy 31 (0.31) 7 to 200 (0.07 to 2.0)

Acute alcoholism 32 (0.32) 13 to 88 (0.13 to 0.88)
Neurosyphilis 68 (0.68) 15 to 4200 (0.15 to 42.0)
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 Typical Cerebrospinal Fluid Findings Tubercula
Test
in BacterialTypes
Various Viralof Meningitis
Fungal r
Opening Elevated Usually normal Variable Variable
pressure

White blood cell ≥1,000 per mm3 <100 per mm3 Variable Variable
count

Cell differential Predominance of Predominance of Predominance of Predominance of

PMNs* lymphocytes† lymphocytes lymphocytes

Protein Mild to marked Normal to Elevated Elevated

elevation elevated

CSF-to-serum Normal to Usually normal Low Low

glucose ratio marked
decrease
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THANK YOU
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