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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
It is produced principally in choroid plexus of each lateral ventricle , exists the brain via the foramine luschka & magendi and flows over cortex to be absorbed into the venous system along the sagittal sinus.
Approx 150ml is produced.
Normal Values of CSF | |
Constituent | Conventional Units |
Glucose | 40 – 70 mg/dl |
Lactate | 1 – 2 mmol/L |
Protein | 15 – 50 mg/dl |
Albumin | 6.6 -44.2 mg/dl |
IgG | 0. 9-5.7 mg/dl |
Ammonia | 25 -80 mcg/dl |
CSF Pressure | 50 -180 mmH2O |
Red cells | O |
Total Leucocyte | 0- 5 mononuclear cells/mm3 |
Lymphocyte | 66 – 70 % |
Monocyte | 30 -50 % |
Neutrophils | None |
| Total Protein | Glucose Ratio | Lactate | Cell count | Typical cytology |
Bacterial Meningitis | I | D | I | >1000 | PNC |
Viral Meningitis | N/I | N/D | N | 10 -1000 | PNC/MNC |
Infectious polyneuropathy | I | N | N | N |
|
Autoimmune | I | N | N | N |
|
SAH | I | N | N | I | Eryththyocytes,macropahages, siderophages |
MS | N | N | N | N/I | MNC |
Leptomeningeal metastases | I | N/D | NA | E/I | Malignant cells, mononuclear |
Protein
Elevated protein are seen in bacterial, crytpotococcal, tuberculous meningits & neuroborreliosis.In viral meningitis protein is raised to a lesser degree.
Non infectious causes includes SAH, CNS Vasculitis, Neoplasm.
Proteins are elevated in 80% of patients with leptomeningeal mets.
Albuminocytologic dissosciation is a hallmark in AIDP &CIDP.
NPH, Spinal stenosis, polyneuropathy and high BMI is assosciated with increased CSF serum albumin quotient.
Oligoclonal Bands
The detection of intrathecal oligoclonal IgG in CSF is useful for diagnosis for MS. It is also used in assisting paraneoplastic disorder, ADEM and CNS infection.
Cytological Examination
It should be performed within 2h after puncture, preferably within 30min because of lysis of RBC and WBC.
CSF Glucose concentration & CSF/serum glucose ration & Ratio
A CSF/S. Glucose ratio less than 0.4 – 0.5 is considered to be pathological.
Increased lactate levels indicates bacterial and fungal infection.
Reference
Harrison
Routine CSF Analysis ; European Handbook of Neurological Management
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor