The clinical significance of lumbar puncture of cerebrospinal fluid, read in one article

*For medical professionals only

4 aspects of a summary of clinical many diseases need to rely on lumbar puncture, such as encephalitis, meningitis, low cranial pressure headache, etc.

• Elevated intracranial pressure: > 180_mmH2O, more common in cerebral edema, intracranial mass lesions, traumatic brain injury, intracranial infection, stroke, venous sinus thrombosis, benign intracranial pressure increase, as well as heart failure, hepatic encephalopathy
  
  

  Uniform and consistent hemochromia: hemorrhage in the subarachnoid space;

  In order to fade: bleeding from puncture injuries;

  Discoloration after centrifugation: fresh bleeding or para-injury;

  Yellowing: stale bleeding

  
  

• Yellow: often caused by abnormal increases in the amount of denatured hemoglobin, bilirubin, or protein in the cerebrospinal fluid, spinal canal obstruction (such as extramedullary tumors), polyneuritis, and meningitis, the protein content in the cerebrospinal fluid is elevated (>1.

  
  

• Slightly green: Pseudomonas aeruginosa meningitis, Streptococcus A meningitis

  
  

• Milky white: mostly due to leukocytosis, commonly caused by various suppurulent bacteria caused by meningitis

  
  

• Brown or black: meningeal melanoma

  
  

• Increase in white blood cells: seen in inflammatory lesions of the meninges of the cerebrospinal membrane and cerebral parenchyma;
• Mild to moderate increase in white blood cells, predominantly lymphocytes: viral encephalitis;
• Marked increase in leukocytes, predominantly neutrophils: acute purulent meningitis;
• A large number of lymphocytes or mononuclear cells are predominantly increased: subacute or chronic infection;
• Predominantly increased eosinophils: cerebral parasite infection
  .
  
  

Cerebrospinal fluid biochemistry 1.
Protein: normal value is 0.
15-0.
45 g/L, children are 0.
20-0.
405 g/L
.

• Significantly elevated cerebrospinal fluid proteins: common in meningitis (significant increase in purulent meningitis, moderate increase in tuberculous meningitis, mild increase in viral meningitis), hemorrhage (subarachnoid hemorrhage and cerebral hemorrhage, etc.
  ), endocrine or metabolic diseases (diabetic neuropathy, hypothyroidism, uremia and dehydration, etc.
  ), drug poisoning (ethanol, phenol thiazide, phenytoin sodium poisoning, etc.
  ).
  
  
• Decreased CSF protein: people with
  lumbar puncture or dural injury that causes CSF loss, extreme weakness, and malnutrition.
  
  

2.
Sugar: the normal value is 1/2-2/3 of blood glucose, 2.
5-4.
4 mmol/L (45-60 mg/dL), < 2.
25 mmol/L is abnormal<b10>.

• Elevated glucose in cerebrospinal fluid: common after a full meal or intravenous glucose injection, bloody cerebrospinal fluid, diabetes mellitus, acute trauma or poisoning of the brainstem, premature infants or newborns, etc
  .
  
• Decreased glucose in cerebrospinal fluid: common in acute purulent meningitis, tuberculous meningitis, and fungal meningitis
  .
  
  

3.
Chloride: normal value 120-130 mmol/L, children 111-123mmol/L
.

• Significant reduction in chloride content in cerebrospinal fluid: electrolyte disorders caused by tuberculous, bacterial, fungal meningitis and systemic diseases, most notably tuberculous meningitis;
  
• Increased chloride content in cerebrospinal fluid: hyperchloremic patients may increase
  .
  
  

Virological testing: ELISA method checks cerebrospinal fluid virus antibodies, such as herpes simplex virus, Epstein-Barr virus, cytomegalovirus, etc
.

• Detection of new cryptococcus: cerebrospinal fluid ink staining (+);
• Tuberculosis bacteria detection: acid-resistant staining (+), tuberculosis bacteria culture;
• Parasite antibody detection;
• Special protein detection;
• Cerebrospinal fluid 14-3-3 protein: common in CJD;
• Cerebrospinal fluid total tau protein, phosphorylated tau protein: common in AD
  .
  
  

2.
Immunoglobulin
normal cerebrospinal fluid IgG content of 10-40 mg/L, IgA content of 1-6 mg/L, IgM content is very small
.

• Increased IgG: more common in neurosyphilis, purulent meningitis, tuberculous meningitis;
• Increased IgA: more common in various meningitis and cerebrovascular diseases;
• IgM elevation: more common in purulent meningitis, virological meningitis, multiple sclerosis, tumors, etc.
  ;
• Increased IgE: more common in cerebral parasitic diseases
  .
  
  

3.
Special antibodies

• Aquaporin antibodies: optic nerve myelitis;
• Ganglioside antibodies: Guillain Barré syndrome, ganglioside antibody lineage diseases;
• Autoimmune-related antibodies: such as NMDAR receptor antibodies, anti-AMPAR antibodies, anti-CASPR2 antibodies, anti-GABABR1/2 antibodies, anti-LGI1 antibodies, anti-IgLON5 antibodies, anti-DPPX antibodies, anti-GAD65 antibodies, etc.
  , autoimmune related encephalitis;
• Paraneoplastic-related antigen antibodies: such as anti-Hu antibodies, anti-Yo antibodies, anti-Ri antibodies, anti-PNMA2 antibodies, anti-amphiphysin antibodies, anti-CV2 antibodies, etc.
  , tumor-related central damage
  .
  
  

4.
Cerebrospinal fluid protein electrophoresis

• increased cerebrospinal fluid protein, decreased or even disappeared ratio of prealbumin: various types of meningitis;
• increased α globulin: more common in intracranial infections and tumors;
• β globulin elevation: more common in amyotrophic lateral sclerosis, degenerative diseases such as Parkinson's disease, and post-traumatic hemiplegia;
• γ globulin is elevated and the total protein volume is normal: more common in multiple sclerosis and neurosyphilis
  .
  
  

Summary:
Cerebrospinal fluid is particularly important for clinicians to diagnose diseases, and has important reference value
for the diagnosis, differential diagnosis, efficacy diagnosis and prognosis evaluation of central nervous system infectious diseases, meningeal cancer, central nervous system leukemia, lymphoma or cerebrovascular disease.

Therefore, cerebrospinal fluid examination can help us quickly identify the type of disease, help with early diagnosis, early medication, and reduce pain
for patients.

References:

ZHANG Jian.
Clinical interpretation of CSF examination results.
Chinese Journal of General Practitioners.
2008,(04).

Zhao Cui,Cheng Guoqiang.
Research status and interpretation of results of neonatal cerebrospinal fluid examination.
Chinese Journal of Evidence-Based Pediatrics.
2016,11(04).

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The source of this article Medical Neurology Channel Author | Yuan Weizhe reviewed this article | Deng Caihong Deputy Chief Physician
Responsible Editor Mr.
Lu Li

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