Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force

Abstract

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 patientsÕ 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.

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

“…Delayed treatment of false negative cases may be fatal. However, high specificity is desired to exclude expensive treatment of false positive cases (8). Previous studies have shown CSF lactate to have the highest sensitivity (89%-100%) and specificity (96%-100%) for discriminating acute untreated bacterial meningitis from viral meningitis, when the threshold limit was set at 3.5 mmol/L (36,37).…”

“…CSF lactic acid (LA) is considered a good biomarker for differentiating bacterial from viral meningitis at a cut-off of 3.5 mmol/L (8)(9)(10)(11)(12).…”

MS and clinically isolated syndromes: Shared specificity but diverging clonal patterns of virus‐specific IgG antibodies produced in vivo and by CSF B cells in vitro

“…The detection of intrathecal synthesis of oligoclonal IgG with IEF is a useful diagnostic tool both in MS and other disorders of the CNS (Deisenhammer 2006). IEF with immunoblot was used to examine the clonal patterns of intrathecally synthesised IgG and of virus-specific…”

Assisting the neurologist in diagnosis of CNS malignancies ‐ Current Possibilities and Limits of Cerebrospinal Fluid Cytology and Immunocytochemistry

“…Laboratory examination of cerebrospinal fluid is irreplaceable for diagnosing a wide spectrum of neurological diseases (Deisenhammer et al., 2006). Cytological examination is considered one of the substantial methods of CSF diagnostics (Sobek et al, 2012).…”

“…Tumorous impairment of CNS is the highest priority for the application of CSF cytology (Deisenhammer et al., 2006; Sobek et al., 2012). It is a minimally invasive diagnostic method, yet capable enough to ensure crucial information concerning not only the mere presence of tumorous cells in CSF but also their closer identification which is fundamental for consecutive therapy and for the patient's prognosis.…”