CSF ANALYSIS

Dr. mamta
 INTRODUCTION –

• CSF is a clear, colorless fluid formed in the

ventricles of the brain by choroid plexus
• Ultrafiltrate of plasma
• It is contained in cerebral ventricles , spinal
canal and subarachnoid space
 NORMAL CSF
• Total volume…100-150ml
• Normally…clear
• Pressure…60-180mm of water
• Normal cell count..0-5cells(in neonates upto 30
cells)
• Cell type…lymphocytes
• Protein…15-45mg%
• Sugar…45-80mg%
• Chloride..120-130mEq/L
• Pandeys test(negative)…detects globulin
• No clot
• No xanthochromia
 FUNCTIONS
1.Protection of brain and spinal cord from
injury by acting as shock absorber
2. To serve as a medium between blood and
brain for supply of nutrients to and removal of
waste products from brain
 COLLECTION OF CSF
• LP needle - Used to draw CSF from lumbar
region
• Site - Usually L3-L4 area is selected
1. Patient lies on one side with legs and neck
flexed,with knees and chin approximated.
Back should be at the edge of the couch.
2.Feel the highest point of iliac crest.Draw a
line across the back down.This crosses the 4th
lumbar spine or between 3rd and 4th lumbar
spine.Mark this area between L3 and L4.
3.clean the area from L2 to L5 with antiseptic
like povidone iodine or chlorhexidine
4.Inject 1% xylocaine for local anaesthetic effect
in to skin and subcutaneous tissues in the area
L3-L4.
5.Introduce the LP needle in to this space along
with stylet.As the needle enters the
subarachnoid space,resistance will be lost.
6. Withdraw the stylet slowly. Collect the CSF
in three sterile bottles for biochemical ,
microbiology and cell count & cytology
7. If pressure has to be assessed,manometer
can be connected to the needle.
 INDICATIONS
1.Suspected meningitis of all types
2.subarachnoid hemorrhage
3.tumors of brain,spinal cord.
4.encephalitis and brain abscess
5.In leukemias and lymphomas for evidence of
CNS involvement,suspected metastasis of CNS
6.To inject radio opaque dyes
7.Neural syphilis(changes in globulin fraction)
8. Guillain barre syndrome(albumino cytologic
dissociation).

Therapeutic indications-
1.spinal anaesthesia
2.Introduction of drugs as in ALL , Lymphomas.
 CONTRAINDICATIONS
1.Marked raise in CSF pressure(diagnosed by
papilloedema(fundoscopy)
2.local infective conditions
3. cardiorespiratory compromise
4. Bleeding diathesis
 COMPLICATIONS
1. Post –puncture headache
2. Introduction of infection
3. Subdural haematoma
4. Herniation of brain
 Increased intracranial pressure
• Headache
• Vomiting
• Decreased Level of Consciousness
• Papilledema
• Herniation
 Gross appearance of CSF
• Yellow CSF..xanthochromia..old hemorrhage
obstructive jaundice, Froin syndrome,
Rifampicin therapy, sub arachnoid
hemorrhage.
• Turbid CSF..due to Pus or RBC,
microorganisms,proteins
• clot- meningitis (tuberculous) , spinal block
 CELL COUNTS IN CSF
• An increase in cell count in CSF – pleocytosis
• Causes of increased cell count in CSF-
- Meningitis & other infections
- intracranial haemorrhage
- meningeal infiltration by malignancy
- injection of foreign substances in
subarachnoid space
 Lymphocytes in CSF
• Inflammatory: viral meningitis, tuberculous
meningitis, fungal meningitis, syphilitic ,SSPE.
• Degenerative: multiple sclerosis, Guillain Barre
syndrome
• Neoplastic: ALL and lymphoma
 Neutrophils in CSF
• meningitis:bacterial, Early viral, early
tuberculous, amoebic encephalomyelitis
• Brain abscess
• Injury:sub arachnoid hemorrhage, intracranial
hemorrhage
 Eosinophils in CSF
• Parasitic:cysticercosis
• Fungal infections
• Acute polyneuritis
• Hypereosinophilic syndrome
 Chemical examination of CSF
• Glucose..levels reduced in infections & cancer
This is due to switch over by brain to
anaerobic glycolysis, utilisation by
inflammatory cells(neutrophils as in pyogenic
meningitis) and to a lesser extent utilisation by
bacteria.
• Chlorides..reduced in TB meningitis.
 Microbiological examination
• Grams stain..meningococci are gram negative
diplococci
• AFB stain especially from cobweb on surface
which forms after standing for one hour.
• India ink prepartion..for fungi like cryptococci.
• Culture
• Serology..like VDRL for syphylis
India ink prepartion- cryptocoocus
Malignant cells in CSF
THANK YOU