Body Fluid Analysis -Cerebrospinal Fluid

Bacterial/ Viral

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No Fasting Required

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Chemical & microscopic study of cerebrospinal fluid.

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Body Fluid Analysis - Cerebrospinal Fluid (CSF)

Why is it done?
- Test Purpose: CSF analysis examines the fluid surrounding the brain and spinal cord to diagnose infections, inflammatory conditions, bleeding, cancer, and metabolic disorders affecting the central nervous system.
- Primary Indications: Suspected meningitis or encephalitis, unexplained fever with neurological symptoms, headache with fever and neck stiffness, neurological disorders, suspected subarachnoid hemorrhage, cancer screening in high-risk patients, monitoring chemotherapy delivery to the CNS
- Typical Timing: Emergency situations requiring immediate diagnosis, acute medical presentations with CNS involvement, routine monitoring of chronic neurological conditions, diagnostic evaluation for unexplained neurological symptoms
Normal Range
- Appearance: Clear, colorless (normal)
- White Blood Cell (WBC) Count: 0-5 cells/µL (or 0-5 × 10⁶/L)
- Red Blood Cell (RBC) Count: 0 cells/µL (or rare in normal CSF)
- Glucose: 40-70 mg/dL (or 2.2-3.9 mmol/L)
- Protein (Total): 15-45 mg/dL (or 150-450 mg/L)
- Chloride: 110-130 mEq/L (or 110-130 mmol/L)
- Opening Pressure: 70-180 mm H₂O (or 5-18 cm H₂O) when in sitting position
- Lactate: <2 mmol/L or <4 mg/dL
- Cultures (Bacterial/Viral/Fungal): Negative (no growth)
- Interpretation of Normal Results: Normal results indicate absence of infection, inflammation, bleeding, or malignancy in the CNS. Clear fluid with appropriate cell counts and chemical composition suggests healthy central nervous system function.
Interpretation
- Elevated WBC Count: >5 cells/µL suggests meningitis (bacterial, viral, fungal, or tuberculous), encephalitis, multiple sclerosis, or other inflammatory CNS conditions. Lymphocytic predominance typically indicates viral or tuberculous infection; neutrophilic predominance suggests bacterial infection.
- Presence of RBCs: Indicates subarachnoid hemorrhage, traumatic tap, or intraventricular hemorrhage. Numerous RBCs (>500/µL) with xanthochromia (yellow discoloration) suggests old bleeding.
- Decreased Glucose (<40 mg/dL): Strongly suggests bacterial meningitis, tuberculous meningitis, fungal meningitis, or CNS lymphoma. Ratio of CSF glucose to serum glucose <0.4 is highly significant.
- Elevated Protein (>45 mg/dL): Indicates infection, inflammation, bleeding, CNS malignancy, or spinal cord compression. Markedly elevated protein (>500 mg/dL) suggests severe infection or spinal block.
- Decreased Chloride (<110 mEq/L): Often accompanies tuberculous meningitis and indicates severe CNS infection.
- Elevated Pressure (>180 mm H₂O): Indicates increased intracranial pressure from meningitis, encephalitis, pseudotumor cerebri, CNS malignancy, or hemorrhage.
- Elevated Lactate (>2 mmol/L): Associated with bacterial meningitis, hypoxia, and anaerobic metabolism. Levels >4 mmol/L indicate severe CNS infection.
- Positive Culture: Identifies causative organism (bacterial, viral, fungal, or mycobacterial) enabling specific treatment. Guide for antibiotic sensitivity and targeted therapy.
- Cloudy or Turbid Appearance: Indicates high cell count or protein content, typically seen in bacterial meningitis (>1000 WBC/µL produces visible turbidity).
- Factors Affecting Results: Traumatic tap (artificial RBCs), delayed processing, patient positioning, blood glucose levels (correlate with CSF glucose), recent intrathecal medications, antibiotic administration before sampling
Associated Organs
- Primary Organ Systems: Central Nervous System (brain, spinal cord, meninges), peripheral nervous system involvement
- Conditions Associated with Abnormal Results: Bacterial meningitis (N. meningitidis, S. pneumoniae, H. influenzae), viral meningitis/encephalitis (enterovirus, HSV, VZV, west nile virus), tuberculous meningitis, fungal meningitis (Candida, Cryptococcus, Coccidioides), parasitic infections, neurosyphilis
- Inflammatory & Autoimmune Diseases: Multiple sclerosis, neurosarcoidosis, lupus cerebritis, autoimmune encephalitis
- Malignancies: Leptomeningeal carcinomatosis, lymphoma (CNS lymphoma), leukemia with CNS involvement, metastatic cancers
- Hemorrhagic Conditions: Subarachnoid hemorrhage, intracerebral hemorrhage, intraventricular hemorrhage
- Metabolic Disorders: Hypoglycemia affecting CSF, hepatic encephalopathy, uremic encephalopathy
- Neurological Degenerative Diseases: Alzheimer's disease, Parkinson's disease, Creutzfeldt-Jakob disease (CJD)
- Potential Complications of Lumbar Puncture: Post-dural puncture headache, spinal epidural hematoma, meningitis (infection at puncture site), spinal cord compression, herniation risk (if significant increased ICP present), nerve root irritation, bleeding (in anticoagulated patients)
Follow-up Tests
- If Infection Suspected: Blood cultures, PCR for viral pathogens (HSV, VZV, enterovirus, west nile virus), bacterial culture sensitivity, Gram stain, acid-fast stain for TB, fungal culture, India ink stain for cryptococcal meningitis
- If Malignancy Suspected: Cytopathology review, flow cytometry, tumor markers (CEA, AFP, PSA depending on primary cancer), MRI brain with contrast, repeat LP after 7-10 days if negative and high suspicion
- If Hemorrhage Suspected: CT head without contrast, CTA head and neck, MRI brain, MRA brain, cerebral angiography if vascular malformation suspected, coagulation studies
- If Inflammatory/Autoimmune Suspected: Oligoclonal bands, IgG index, myelin oligodendrocyte glycoprotein (MOG) antibodies, aquaporin-4 (AQP4) antibodies, anti-NMDA receptor antibodies, MRI brain with contrast, serum autoimmune panel
- If Raised Intracranial Pressure: MRI brain (to rule out mass), fundoscopy (papilledema assessment), repeat LP for pressure monitoring, imaging based on clinical presentation
- General Imaging: MRI brain with gadolinium (preferred), CT head if MRI contraindicated, neuroimaging to assess for complications
- Monitoring Frequency: Acute infections: repeat LP may be performed after 48-72 hours if no improvement or deterioration. Chronic conditions (MS, neurosarcoidosis): repeat LP based on clinical course. Malignancy: repeat LP for cytology during intrathecal chemotherapy administration
Fasting Required?
- Fasting Status: No - Fasting is NOT required for CSF analysis. The test analyzes cerebrospinal fluid obtained via lumbar puncture, not blood.
- Special Considerations: Serum glucose levels should be obtained concurrently to calculate CSF-to-serum glucose ratio for diagnostic purposes; fasting state may be preferred for serum glucose comparison but not mandatory
- Patient Preparation Requirements: Empty bladder before procedure, position change (lateral decubitus position preferred for lumbar puncture), void colon if possible, consent obtained, explain procedure risks/benefits
- Medications to Avoid: Anticoagulants (warfarin, DOACs) - hold if possible or delay procedure; antiplatelet agents (aspirin, clopidogrel) - typically discontinued 5-7 days prior if feasible; NSAIDs - hold 24 hours before; recent thrombolytics - absolute contraindication; sedating medications - avoid immediately before procedure
- Pre-procedure Instructions: Imaging (CT or MRI) may be required before LP to rule out contraindications (increased ICP, mass effect, abnormal anatomy), allow food and fluids unless sedation planned, arrange transportation if conscious sedation used, place IV line for emergency medications, empty bowels/bladder
- Post-procedure Recommendations: Lie flat for 2-6 hours to reduce post-dural puncture headache risk, maintain hydration (increased fluid intake), rest for remainder of day, avoid strenuous activity for 24-48 hours, acetaminophen for headache management, caffeine may provide symptomatic relief

How our test process works!