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Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force
Author(s) -
Deisenhammer F.,
Bartos A.,
Egg R.,
Gilhus N. E.,
Giovani G.,
Rauer S.,
Sellebjerg F.
Publication year - 2006
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2006.01493.x
Subject(s) - medicine , cerebrospinal fluid , pleocytosis , csf albumin , albumin , meningitis , pathological , pathology , csf pleocytosis , staining , viral meningitis , grading (engineering) , antibody , immunology , bacterial meningitis , surgery , civil engineering , engineering
A great variety of neurological diseases require investigation of cerebrospinal fluid (CSF) to prove the diagnosis or to rule out relevant differential diagnoses. The objectives were to evaluate the theoretical background and provide guidelines for clinical use in routine CSF analysis including total protein, albumin, immunoglobulins, glucose, lactate, cell count, cytological staining, and investigation of infectious CSF. The methods included a Systematic Medline search for the above‐mentioned variables and review of appropriate publications by one or more of the task force members. Grading of evidence and recommendations was based on consensus by all task force members. It is recommended that CSF should be analysed immediately after collection. If storage is needed 12 ml of CSF should be partitioned into three to four sterile tubes. Albumin CSF/serum ratio ( Q alb ) should be preferred to total protein measurement and normal upper limits should be related to patients’ age. Elevated Q alb is a non‐specific finding but occurs mainly in bacterial, cryptococcal, and tuberculous meningitis, leptomingeal metastases as well as acute and chronic demyelinating polyneuropathies. Pathological decrease of the CSF/serum glucose ratio or increased lactate concentration indicates bacterial or fungal meningitis or leptomeningeal metastases. Intrathecal immunoglobulin G synthesis is best demonstrated by isoelectric focusing followed by specific staining. Cellular morphology (cytological staining) should be evaluated whenever pleocytosis is found or leptomeningeal metastases or pathological bleeding is suspected. Computed tomography‐negative intrathecal bleeding should be investigated by bilirubin detection.