Csf analysis

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CSF ANALYSIS INTERPRETATION

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  • CSF ANALYSIS INTERPRETATION

  • Composition of Normal CSF

    Protein-15 - 45 mg/dLGlucose-50 - 80 mg/dLUrea- 6.0 - 16 mg/dLUric acid- 0.5 - 3.0 mg/dLCreatinine- 0.6 - 1.2 mg/dLCholesterol- 0.2 - 0.6 mg/dLAmmonia-10 35 g/dL

  • Composition of Normal CSFSodium-135 150 mEq/LPotassium- 2.6 3.0 mEq/LChloride-115 130 mEq/LMagnesium - 2.4 3.0 mEq/LCells- 0 5 Lymph/L

  • Characteristics of normal CSFColor - ColorlessPH - 7.28 7.32Appearance- ClearSp. Gravity- 1.003 1.004No clot formation on standingTotal solids - 0.85 1.70 g/dLPO2 - 40 44 mmHg

  • Diagnosis by CSFHigh sensitivity, high specificityBacterial, TB, and fungal meningitisHigh sensitivity, moderate specificityViral meningitis, SAH, CNS syphilis, abscessModerate sensitivity, high specificityMeningeal malignancyModerate sensitivity, moderate specificityIntracranial hemorrhage, viral encephalitis, subdural hematoma

  • XanthochromiaPink, orange, or yellow discolorationRBC lysis or hemoglobin breakdownMay be seen within hours of LPPeak intensity at 24 - 36 hoursRBC > 6000/L (SAH, ICH, infarct, traumatic)Oxyhemoglobin, bilirubin, increased proteinCarotinoids, melanin, rifampin therapy

  • Reference Intervals for CSF

    Cell type

    Adults(%)

    Neonates(%)

    Lymphocytes

    62

    20

    Monocytes

    36

    72

    Neutrophils

    2

    3

    Histiocytes

    Rare

    5

    Ependymal

    Rare

    Rare

    Eosinophils

    Rare

    Rare

  • Increased Neutrophils in CSFMeningitis (bacterial, early TB, fungal)Other infectionsFollowing seizuresFollowing CNS hemorrhageFollowing CNS infarctReaction to repeated LPForeign materialsMetastatic tumor

  • Increased Lymphocytes in CSFMeningitis (aseptic, viral, L monocytogenes)Parasitic infectionsDegenerative disordersEncephalopathy due to drugs, GBSOther inflammatory conditionsSarcoidosis, polyneuritis, periarteritis involving the CNS

  • Increased CSF Total Protein Increased blood-CSF permeabilityMeningitis (bacterial, fungal, TB)Hemorrhage (SAH, ICH)Endocrine disordersMechanical 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 Meningitis0 - 1m: Group B strept & E. coli (GNR)1m - 5y: H. influenzae5 - 29y: N. meningitidis>29y: S. pneumoniaeListeria monocytogenes common in newborns, elderly, and other immunocompromised hosts

  • TestAppearancePressureWBC/LProtein mg/dLGlucose mg/dLChlorideNormal CSFClear90 180 mm 0-8 lymph.15-4550-80115-130 mEq/LAcute bacterial meningitisTurbidIncreased1000 -10000100 500< 40DecreasedViral meningitisClearNormal to moderate increase5-300, rarely >1000Normal to mild increasedNormalNormalTubercular meningitisSlightly opaque cobweb formation Increased/ decreased, spinal block100-600 mixed or lymph.50-300 due to spinal blockDecreasedDecreasedFungal meningitisClearIncreased40-400 mixed50-300DecreasedDecreasedAcute syphiliticClearIncreasedAbout 500 lymphIncreased but