Cerebrospinal Fluid (CSF) exam

Contraindications for Lumbar Puncture

Raised intracranial pressure
Local infective lesion
Disseminated sclerosis
Brain tumor.
CSF (3-5 ml) collected in sterile plain tubes as follows:
Tube 1: Chemistry (glucose and protein) & serology
Tube 2: Microbiology (Gram's stain, C&S)
Tube 3: Hematology (Total cell count & differential count)
Tube 4: Cytology, special studies.
Parameter
Normal value
CSF pressure
Adults & kid 6-8 yrs
90-180 mm of water
in lateral position,
infant/kid <6 yrs 40100 mm of water

Color & Appearance

(Examine w/i 1 hr of collection to
avoid false +ve from lysis of RBCs.
Centrifuge CSF & examine against
white background.)

Normal CSF is clear &

watery.

WBC
Cells begin to lyse w/i 1 hr. Do cell count w/i 30 min
of collection. CSF diluting fluid lyze RBCs & stain WBC.

Adult: 05/L
Newborn: 030/L
(mononuclear)

Interpretation
Causes of CSF
pressure: Meningitis,
cerebral edema, & mass
lesions in brain.
Causes of CSF
pressure: Dehydration &
circulatory collapse.
Turbid CSF pus or RBCs.
Xanthochromia (yellow
CSF)
Old hg
Obstructive jaundice
protein
in meningitis.

CSF specimen diluted 1:20 via pipette with diluting fluid &
cells counted under low power using a Neubauer counting
chamber.. Can be done automated analyzers of

sufficient sensitivity. Differential count on stained

smear following concentration (cytocentrifugation).
RBC

Other cells

Glucose (blood glucose method)

Protein
1) Turbidimetric method: Use
trichloroacetic acid (TCA) or
sulfosalicylic acid (SSA) & sodium
sulphate for protein precipitation
2) Colorimetric method:
* Uses Lowry method (Folin phenol
reagent)

with subarachnoid
hemorrhage,
traumatic tap. (limited dx
value)
CSF may contain immature hematopoietic cells &
other cells (ependymal cells, pia arachnoid
mesothelial cells) & malignant cells. CSF exam
commonly carried out in acute lymphoblastic
leukemia to detect involvement of CNS. WBC count
(>5/l) with lymphoblasts indicate CNS involvement.
60-70% (2/3) of
in bact meningitis
blood glucose
15-45 mg/dl.
in meningitis & with traumatic
(Normal CSF
tap.
proteins =
1% of plasma
proteins).

* Dye binding method using

Coomassie brilliant blue (CBB) or
Ponceau S
* Biuret method
Microbiological Examination
Direct wet mount of CSF: in suspected cryptococcosis, amebic meningoencephalitis,
Candida & trypanosomiasis
Gram's smear: should be done if CSF is turbid & neutrophils.
Ziehl-Neelsen smear: if tuberculous meningitis is suspected. AFB smears are -ve in ~70%
of Tb meningitis. Fluorescent auramine stains have better sensitivity than ZN stain.
Latex agglutination tests: for detection of bact and cryptococcal antigens.
Culture for bact and Mycobacterium tuberculosis
Polymerase chain reaction for Mycobacterium tuberculosis & viruses.