CSF Interpretation

Question 1

Typical pathogens

Answer 1

Bacteria newborn- group B strep, E. coli, listeria

Bacteria young children- N. meningitidis, strep pneumoniae, H. Influenzae

Bacteria teens/ adults- strep pneumoniae, N meningitidis, listeria

Virus- VZV, HIV, enterovirus

Fungal- cryptococcus neoformans

Question 2

Viral infection (encephalitis or meningitis)

Answer 2

Appearance- clear 
WCC- elevated 
Predominant WC- lymphocyte (mononuclear) 
Protein- normal to elevated 
Glucose- normal
Opening pressure- normal/ slightly high

Question 3

Bacterial meningitis

Answer 3

Appearance- cloudy/ turbid 
WCC- extremely elevated 
Predominant WC- neutrophils (polymorph) 
Protein- increased (above 1)
Glucose- decreased 
Opening pressure- high

Question 4

Fungal meningitis

Answer 4

Appearance- fibrin web 
WCC- normal to elevated 
Predominant WC- lymphocyte 
Protein- slightly increased 
Glucose- normal or slightly decreased 
Opening pressure- high to very high

Question 5

TB meningitis

Answer 5

Appearance- cloudy and viscous 
WCC- high 
Predominant WC- lymphocyte (earlier- neutrophils, PMN)
Protein- elevated 
Glucose- very decreased 
Opening pressure- high

Question 6

Additional Tests

Answer 6

Culture and sensitivities- grow bacteria
Microscopy and gram stain
PCR- viruses inc. HSV
Test for xanthochromia- photospectrometry
Cytology- malignant cells
Electrophoresis- oligoclonal bands in MS and transverse myelitis

Question 7

Traumatic Lumbar Puncture

Answer 7

Reason why there maybe red cells present in the fluid. Think SAH also- xanthochromia (straw coloured CSF)

Question 8

SAH

Answer 8

Appearance: Xanthochromia, bloody, or clear
Opening pressure: Elevated
WBC count: (1 additional WBC per 1000 RBCs is considered normal correction)
Glucose level: Normal
Protein level: Elevated (blood broken down-protein)
Additional tests: CSF Gram stain and culture, photospectometry to examine for xanthochromia

Question 9

Meningitis complications

Answer 9

Sensorineural hearing loss (main)

Hydrocephalus (TB & bacterial)

Question 10

Tertiary Syphillis

Answer 10

VDRL, TPHA, FPA positive

Question 11

Viral meningitis or encephalitis

Answer 11

If CSF is thought to be contained with a virus, whether it is meningitis or encephalitis depends not only on imaging, but also clinical history and picture (encephalitis patients more sick- they may have focal neurology, behavioural changes, seizures etc.)

Question 12

Idiopathic intracranial hypertension

Answer 12

All normal except raised opening pressure (young female with raised BMI)

Question 13

Guillian barre syndrome

Answer 13

Increased protein
Everything else normal
ALBUMINOCYTOLOGICAL DISSOCIATION