Csf analysis
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Transcript of Csf analysis
CSF ANALYSIS INTERPRETATION
Composition of Normal CSF
Protein - 15 - 45 mg/dL Glucose - 50 - 80 mg/dL Urea - 6.0 - 16 mg/dL Uric acid - 0.5 - 3.0 mg/dL Creatinine - 0.6 - 1.2 mg/dL Cholesterol - 0.2 - 0.6 mg/dL Ammonia - 10 – 35 μg/dL
Composition of Normal CSF Sodium - 135 – 150 mEq/L Potassium - 2.6 – 3.0 mEq/L Chloride - 115 – 130 mEq/L Magnesium - 2.4 – 3.0 mEq/L Cells - 0 – 5 Lymph/μL
Characteristics of normal CSF• Color - Colorless• PH - 7.28 – 7.32• Appearance - Clear• Sp. Gravity - 1.003 – 1.004• No clot formation on standing• Total solids - 0.85 – 1.70 g/dL• PO2 - 40 – 44 mmHg
Diagnosis by CSF• High sensitivity, high specificity– Bacterial, TB, and fungal meningitis
• High sensitivity, moderate specificity– Viral meningitis, SAH, CNS syphilis, abscess
• Moderate sensitivity, high specificity–Meningeal malignancy
• Moderate sensitivity, moderate specificity– Intracranial hemorrhage, viral encephalitis,
subdural hematoma
Xanthochromia• Pink, orange, or yellow discoloration• RBC lysis or hemoglobin breakdown• May be seen within hours of LP• Peak intensity at 24 - 36 hours• RBC > 6000/μL (SAH, ICH, infarct, traumatic)• Oxyhemoglobin, bilirubin, increased protein• Carotinoids, melanin, rifampin therapy
Reference Intervals for CSFCell type Adults(%) Neonates(%)
Lymphocytes 62 20Monocytes 36 72Neutrophils 2 3Histiocytes Rare 5Ependymal Rare RareEosinophils Rare Rare
Increased Neutrophils in CSF• Meningitis (bacterial, early TB, fungal)• Other infections• Following seizures• Following CNS hemorrhage• Following CNS infarct• Reaction to repeated LP• Foreign materials• Metastatic tumor
Increased Lymphocytes in CSF• Meningitis (aseptic, viral, L monocytogenes)• Parasitic infections• Degenerative disorders– Encephalopathy due to drugs, GBS
• Other inflammatory conditions– Sarcoidosis, polyneuritis, periarteritis involving
the CNS
Increased CSF Total Protein
• Increased blood-CSF permeability–Meningitis (bacterial, fungal, TB)– Hemorrhage (SAH, ICH)– Endocrine disorders–Mechanical obstruction (tumor, disc, abcess)– Neurosypilis, MS, CVD
•Causes of decreased CSF glucose• Increased CSF glucose is of no clinical
significance.• Meningitis-Bacterial, fungal tubercular and
syphilitic meningitis. • Tumors involving the meninges.• Subarachnoid hemorrhage.• Cerebral ameobiasis.
Bacterial Meningitis• 0 - 1m: Group B strept & E. coli (GNR)• 1m - 5y: H. influenzae• 5 - 29y: N. meningitidis• >29y: S. pneumoniae• Listeria monocytogenes common in
newborns, elderly, and other immunocompromised hosts
Test Appearance Pressure WBC/μL Protein mg/dL
Glucose mg/dL
Chloride
Normal CSF
Clear 90 – 180 mm
0-8 lymph. 15-45 50-80 115-130 mEq/L
Acute bacterial meningitis
Turbid Increased 1000 -10000
100 – 500 < 40 Decreased
Viral meningitis
Clear Normal to moderate increase
5-300, rarely >1000
Normal to mild increased
Normal Normal
Tubercular meningitis
Slightly opaque cobweb formation
Increased/ decreased, spinal block
100-600 mixed or lymph.
50-300 due to spinal block
Decreased Decreased
Fungal meningitis
Clear Increased 40-400 mixed
50-300 Decreased Decreased
Acute syphilitic
Clear Increased About 500 lymph
Increased but <100
Normal normal