CSF analysis

Definition

Cerebrospinal fluid (CSF) analysis is a group of laboratory tests that measure chemicals in the cerebrospinal fluid. CSF is a clear fluid that surrounds and protects the brain and spinal cord. The tests may look for proteins, sugar (glucose), and other substances.

Alternative Names

Cerebrospinal fluid analysis

How the Test is Performed

A sample of CSF is needed. A lumbar puncture, also called a spinal tap, is the most common way to collect this sample. Less common ways to take a fluid sample include:

Cisternal puncture
Removal of CSF from a tube that is already in the CSF, such as a shunt, ventricular drain, or pain pump
Ventricular puncture

After the sample is taken, it is sent to the laboratory for evaluation.

Your health care provider will ask you to lie flat for at least one hour after the lumbar puncture. You may develop a headache after the lumbar puncture. If it happens, fluids and drinking caffeinated beverages such as coffee, tea or soda may help.

How to Prepare for the Test

Your provider will tell you how to prepare for lumbar puncture. Make sure to let them know all of the medicines you are taking in case any adjustment is needed.

Why the Test is Performed

Analysis of CSF can help detect certain conditions and diseases. All of the following can be, but are not always, measured in a sample of CSF:

Antibodies and DNA of common viruses
Bacteria (including that which causes syphilis, using a VDRL test)
Cell count
Chloride
Cryptococcal antigen
Glucose
Glutamine
Lactate dehydrogenase
Oligoclonal banding to look for specific proteins
Myelin basic protein
Total protein
Whether there are cancerous cells present (CSF cytology)
Opening pressure

Normal Results

Normal results include:

Antibodies and DNA of common viruses: None
Bacteria: No bacteria grows in a lab culture
Cancerous cells: No cancerous cells present
Cell count: 0 to 5 white blood cells (all mononuclear) and 0 red blood cells
Chloride: 110 to 125 mEq/L (110 to 125 mmol/L)
Fungus: None
Gamma globulin: 3% to 12% of the total protein
Glucose: 50 to 80 mg/dL or 2.77 to 4.44 mmol/L (or greater than two-thirds of blood sugar level)
Glutamine: 6 to 15 mg/dL (410.5 to 1,026 micromol/L)
Lactate dehydrogenase: less than 40 U/L
Oligoclonal bands: 0 or 1 bands that are not present in a matched serum sample
Protein: 15 to 60 mg/dL (0.15 to 0.6 g/L)
Opening pressure: 70 to 180 mm of water
Myelin basic protein: Less than 4ng/mL

Normal value ranges may vary slightly among different laboratories. Talk to your provider about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

An abnormal CSF analysis result may be due to many different causes, including:

Cancer
Encephalitis (such as Herpes simplex, West Nile, and Eastern Equine Encephalitis virus)
Hepatic encephalopathy
High blood sugar (hyperglycemia)
Infection
Inflammation
Reye syndrome
Meningitis due to bacteria, fungus, tuberculosis, or a virus
Multiple sclerosis (MS)
Alzheimer disease
Pseudotumor cerebrii
Normal pressure hydrocephalus

References

Euerle BD. Spinal puncture and cerebrospinal fluid examination. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 60.

Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022: chap 88.

Schnapp BH, Jewell C. Central nervous system infections. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 95.