CSF analysis

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.

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.

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 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.

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

Cerebrospinal fluid analysis

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.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.