Healthcare and Medicine Reference
In-Depth Information
Table 7.1 Typical CSF in meningitis.
Normal
Bacterial
Viral
Tuberculosis
Pressure
5-20 cm CSF
Often
Often
Often
Appearance
Clear
Turbid/purulent
Clear
Turbid
Predominant cell
Nil
Neutrophils
Lymphocytes
Lymphocytes
<5/mm 3
<50/mm 3
50-500/mm 3
100-1000/mm 3
Lymphocytes
Neutrophils
0
>200/mm 3
0
<200/mm 3
Protein
0.1-0.4 g/L
>1.5 g/L
<1 g/L
1-5 g/L
Glucose
2-4 mmol/L
<50% plasma glucose
>50% plasma glucose
<50% plasma glucose
>50% plasma glucose
Gram stain
Normal
May show organisms
Normal
Normal
Haematoma —A spinal subdural or epidural haematoma can cause
spinal cord compression and requires urgent MRI and emergency
neurosurgical drainage.
Further reading
Boon JM, Abrahams PH, Meiring JH, Welch T. (2004) Lumbar punctures:
anatomical review of a clinical skill. Clin Anat 17: 544-53.
Ellenby MS, Tegtmeyer K, Lai S, Braner DAV. (2006) Lumbar puncture.
N Engl J Med 355: e12.
Evans RW. (1998) Complications of lumbar puncture. Neurol Clin 16:
83-105.
Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. (2001) Computed tomogra-
phy of the head before lumbar puncture in adults with suspected
meningitis. N Engl J Med 345: 1727.
Kneen R, Solomon T, Appleton R. (2002) The role of lumbar puncture in
suspected CNS infection - a disappearing skill? Arch Dis Child 87: 181-3.
Straus S, Thorpe K. (2006) How do I perform a lumbar puncture and analyze
the results to diagnose bacterial meningitis? JAMA 296: 2012-22.
Van de Beek D, de Gans J, Tunkel AR, Wijdicks EFM. (2006) Community-
acquired bacterial meningitis in adults. N Engl J Med 354: 44.
Cerebellar tonsillar herniation (coning) —In the presence of increased
ICP the cerebellar tonsils may be forced through the foramen mag-
num, resulting in compression of the medulla and neurological
deterioration or death.
Interpretation of results
See Table 7.1.
Blood in CSF - subarachnoid haemorrhage or
bloody tap?
Bloody tap is suggested by:
drop in RBC count in successive collection tubes
no xanthochromia - yellow supernatant on spun CSF.
Causes of increased CSF protein
Protein
↑↑
Protein
Bacterial meningitis
Severe bacterial meningitis
Multiple sclerosis
Tuberculosis
Guillain-Barré syndrome
Spinal tumours
Acoustic neuroma
Handy hints/troubleshooting
Patient positioning is key - take the time to get this right.
Spend time obtaining consent and discussing the procedure with
the patient - this should alleviate their fears and allow them to
help you by optimal positioning.
Be absolutely sure that you are in the midline, especially with
overweight patients.
Ensure your assistant is well prepared, with bottles open, labelled
and in the correct order.
If you want to exclude infection, remember to take a venous
blood glucose level for comparison to the CSF result.
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