CSF Interpretation

Question 1

What is the normal CSF appearence and values?

Answer 1

Normally clear and colourless.
0-5 WBC
Protein <1% of serum
Glucose > 60% of serum

Question 2

What are the following CSF findings for bacterial meningitis:
* Appearence
* Oppening pressure
* WBC
* Glucose level
* Protein level

Answer 2

• Appearence - cloudy and turbid
• Oppening pressure - Elevated
• WBC - Elevated
• Glucose level - low
• Protein level - elevated

Question 3

What are the common causes of bacterial meningitis in adults?

Answer 3

• Neisseria meningitisis
• Streptococcus pneumoniae
• Listeria monocytogenes

Question 4

What are some further investigations to assist diagnosis of bacterial meningitis?

Answer 4

• CSF gram stain and culture
• CSF bacterial antigens
• CSF PCR
• Imaging

Question 5

What is the presentation of meningitis?

Answer 5

Headache
Fever
Neck stiffness
Photophobia
Petechial rash if meningococcal

Question 6

What are the following CSF findings for viral meningitis:
* Appearence
* Oppening pressure
* WBC
* Glucose level
* Protein level

Answer 6

• Appearence - clear
• Oppening pressure - Normal/elevated
• WBC - Elevated
• Glucose level - Normal
• Protein level - Elevated

Differs from bacterial in appearence and glucose levels

Furhter investigations = CSF PCR

Question 7

What are some causes of viral meningitis?

Answer 7

• HSV
• VZV
• Mumps
• HIV

Question 8

What are the following CSF findings for fungal meningitis:
* Appearence
* Oppening pressure
* WBC
* Glucose level
* Protein level

Answer 8

• Appearence - clear or cloudy
• Oppening pressure - elevated
• WBC - elevated
• Glucose level - low
• Protein level - elevated

Question 9

What are the clinical features of tuberculosis menigitis?

Answer 9

Headache, fever, neck stiffness, photophobia, delerium and cranial nerce palsies

Question 10

What are the following CSF findings for SAH:
* Appearence
* Oppening pressure
* WBC
* Glucose level
* Protein level

Answer 10

• Appearence - blood stained then xanthochromia (yellow)
• Oppening pressure - Elevated
• WBC - Elevated
• Glucose level - Normal
• Protein level - Elevated

Do head CT, CT angiography and cerebral angiogram

Question 11

What are the following CSF findings for multiple sclerosis:
* Appearence
* Oppening pressure
* WBC
* Glucose level
* Protein level

Answer 11

• Appearence - clear
• Oppening pressure - Normal
• WBC - Mildt elevated/normal
• Glucose level - normal
• Protein level - mildly elevated
• Electrophoresis shows IgG oligobands

Do MRI with gadalinum

Question 12

What are the clinical features of MS?

Answer 12

Optic neuritis, limb weakness, sensory deficit, diplopia, ataxia