Chapter 603  ◆  Central Nervous System Infections  2937

Table 603-1  Cerebrospinal Fluid Findings in Central Nervous System Disorders

PRESSURE PROTEIN GLUCOSE
CONDITION (mm H2O) LEUKOCYTES (mm3) (mg/dL) (mg/dL) COMMENTS
Normal 50-80 <5, ≥75% Lymphocytes 20-45 >50 (or 75%
serum glucose)
COMMON FORMS OF MENINGITIS
Acute bacterial Usually elevated 100-10,000 or more; usually Usually Decreased, Organisms usually seen on
meningitis (100-300) 300-2,000; PMNs 100-500 usually <40 (or Gram stain and recovered
predominate <50% serum by culture
glucose)
Partially treated Normal or 5-10,000; PMNs usual but Usually Normal or Organisms may be seen on
bacterial meningitis elevated mononuclear cells may 100-500 decreased Gram stain
predominate if pretreated Pretreatment may render
for extended period of CSF sterile. Antigen may
time be detected by
agglutination test
Viral meningitis or Normal or slightly Rarely >1,000 cells. Eastern Usually 50-200 Generally normal; HSV encephalitis is
meningoencephalitis elevated equine encephalitis and may be suggested by focal seizures
(80-150) lymphocytic decreased to or by focal findings on CT
choriomeningitis may <40 in some or MRI scans or EEG.
have cell counts of several viral diseases, Enteroviruses and HSV
thousand. PMNs early but particularly infrequently recovered
mononuclear cells mumps (15-20% from CSF. HSV and
predominate through of cases) enteroviruses may be
most of the course detected by PCR of CSF
UNCOMMON FORMS OF MENINGITIS
Tuberculous Usually elevated 10-500; PMNs early, but 100-3,000; may <50 in most cases; Acid-fast organisms almost
meningitis lymphocytes predominate be higher in decreases with never seen on smear.
through most of the presence of time if Organisms may be
course block treatment is not recovered in culture of
provided large volumes of CSF.
Mycobacterium
tuberculosis may be
detected by PCR of CSF
Fungal meningitis Usually elevated 5-500; PMNs early but 25-500 <50; decreases Budding yeast may be seen.
mononuclear cells with time if Organisms may be
predominate through treatment is not recovered in culture.
most of the course. provided Cryptococcal antigen (CSF
Cryptococcal meningitis and serum) may be positive
may have no cellular in cryptococcal infection
inflammatory response
Syphilis (acute) and Usually elevated 50-500; lymphocytes 50-200 Usually normal Positive CSF serology.
leptospirosis predominate Spirochetes not
demonstrable by usual
techniques of smear or
culture; dark-field
examination may be
positive
Amebic (Naegleria) Elevated 1,000-10,000 or more; PMNs 50-500 Normal or slightly Mobile amebas may be seen
meningoencephalitis predominate decreased by hanging-drop
examination of CSF at
room temperature
BRAIN ABSCESSES AND PARAMENINGEAL FOCUS
Brain abscess Usually elevated 5-200; CSF rarely acellular; 75-500 Normal unless No organisms on smear or
(100-300) lymphocytes predominate; abscess culture unless abscess
if abscess ruptures into ruptures into ruptures into ventricular
ventricle, PMNs ventricular system
predominate and cell system
count may reach >100,000
Subdural empyema Usually elevated 100-5,000; PMNs 100-500 Normal No organisms on smear or
(100-300) predominate culture of CSF unless
meningitis also present;
organisms found on tap of
subdural fluid
Cerebral epidural Normal to slightly 10-500; lymphocytes 50-200 Normal No organisms on smear or
abscess elevated predominate culture of CSF
Spinal epidural Usually low, with 10-100; lymphocytes 50-400 Normal No organisms on smear or
abscess spinal block predominate culture of CSF
Chemical (drugs, Usually elevated 100-1,000 or more; PMNs 50-100 Normal or slightly Epithelial cells may be seen
dermoid cysts, predominate decreased within CSF by use of
myelography dye) polarized light in some
children with dermoids
Continued