CSF collection

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CSF chemistry

Lumbar vertebrae

Spinal tap; Ventricular puncture; Lumbar puncture; Cisternal puncture; Cerebral spinal fluid culture

• Pressure: 50 - 180 mm H20
• Appearance: clear, colorless
• CSF total protein : 15 - 45 mg/100 ml
• Gamma globulin: 3 - 12% of the total protein
• CSF glucose : 50 - 80 mg/100 ml (or approximately 2/3 of serum glucose level)
• CSF cell count : 0 - 5 white blood cells (WBC), no red blood cells (RBC)
• Chloride: 110 - 125 mEq per liter

Note: mg/ml = milligrams per milliliter; mEq/L = milliequivalent per liter

• Pressure, increased: increased intracranial pressure (pressure within the skull) from trauma or infection
• Pressure, decreased: obstruction to the flow of CSF above the puncture site (spinal cord tumor), shock, fainting, diabetic coma
• Appearance
  • Cloudy: infection, white blood cells in the CSF, protein in the CSF, microorganisms
  • Bloody or reddish colored: bleeding within the brain or subarachnoid space, spinal cord obstruction, traumatic lumbar puncture (first specimen bloody, rest clear)
  • Brown, orange, yellow color: elevated protein in the CSF, old (greater than 3 days) blood in the CSF
• Protein, increased: blood in the CSF, diabetes, polyneuritis, tumors, trauma, any inflammatory or infectious condition
• Protein, decreased: rapid CSF production
• Gamma globulin, increased: demyelinating disease such as multiple sclerosis, neurosyphilis, Guillain-Barre syndrome
• Glucose, increased: systemic hyperglycemia (elevated blood sugar)
• Glucose, decreased: systemic hypoglycemia (low blood sugar), bacterial or fungal infection (such as meningitis), tuberculosis, carcinomatous meningitis
• WBC, increased: active meningitis, acute infection, beginning of a chronic illness, tumor, abscess, brain infarction (stroke), demyelinating disease (such as multiple sclerosis)
• RBC: bleeding into the spinal fluid, traumatic lumbar puncture

Additional conditions under which the test may be performed:

• Chronic inflammatory polyneuropathy
• Dementia due to metabolic causes
• Encephalitis
• Epilepsy
• Febrile seizure (children)
• Generalized tonic-clonic seizure
• Hydrocephalus
• Inhalation anthrax
• Normal pressure hydrocephalus (NPH)
• Pituitary tumor
• Reye's syndrome

Review Date: 05/12/2005
Reviewed By: Chitra R. Uppaluri MD, Clinical Asst. Professor of Medicine, Saint Louis University, Saint Louis MO. Review provided by VeriMed Healthcare Network.