CSF collection

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

CSF chemistry

CSF collection

Alternative Names:

Spinal tap; Ventricular puncture; Lumbar puncture; Cisternal puncture; Cerebral spinal fluid culture
Normal Values:

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

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

What abnormal results mean:

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:

References:

Nathan, BR. Cerebrospinal Fluid and Intracranial Pressure. In: Goetz, CG, ed. Textbook of Clinical Neurology, 2nd ed. Philadelphia, Pa:WB Saunders Company; 2003:511-524.