Template:Lumbar Puncture Diagnosis: Difference between revisions
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| align="center" style="background:#f0f0f0;"|'''Measure''' | |||
| align="center" style="background:#f0f0f0;"|'''Normal''' | |||
| align="center" style="background:#f0f0f0;"|'''[[Bacterial meningitis|Bacterial]]''' | |||
| align="center" style="background:#f0f0f0;"|'''[[Viral meningitis|Aseptic (Viral)]]''' | |||
| align="center" style="background:#f0f0f0;"|'''[[Fungal meningitis|Fungal]]''' | |||
| align="center" style="background:#f0f0f0;"|'''[[Tuberculosis]]''' | |||
| align="center" style="background:#f0f0f0;"|'''[[Subarachnoid hemorrhage]]''' | |||
| align="center" style="background:#f0f0f0;"|'''Neoplastic''' | |||
|- | |- | ||
| ''' | | '''Appearance'''||Clear||Clear, cloudy, or purulent||Clear||Clear or opaque||Clear or opaque||Xanthochromia, bloody, or clear||Clear or opaque | ||
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| Opening Pressure | | '''Opening Pressure (cm H2O)'''||10-20||>25||Normal or elevated||>25||>25||>25||Normal or elevated | ||
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| WBC Count^ | | '''WBC Count^ (cells/µL)'''||0-5^||>100^||5-1000||<500|| 50-500||0-5 (see correction section)||<500 | ||
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| | | '''% PMNs'''||||>80-90%||1-50%^^||1-50%||Early PMN then lymph||||1-50% | ||
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| 1-50% | |||
| 1-50% | |||
| 1-50% | |||
|- | |- | ||
| Glucose | | '''Glucose'''||>60% of serum glucose|| Low||Normal||Low||Low||Normal||Normal | ||
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| Protein | | '''Protein^^^ (mg/dL)'''||< 45||Elevated||Elevated||Elevated||Elevated||Elevated||>200 | ||
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| Gram Stain | | '''Gram Stain'''||Neg||Pos||Neg||India ink||Tb stain||Blood|| | ||
| Pos | |||
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| India ink | |||
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|} | |} | ||
^For | *^Normal or lower WBC results may be found in immunocompromised, early, or partially treated (e.g. with oral antibiotics) bacterial menintigis, and those with tuberculosis meningitis | ||
*^^Lymph predominance may be found in patients with early bacterial meningitis or those that have been partially treated (e.g. with oral antibiotics) | |||
*^^^For unexplained elevations of protein, consider [[encephalitis]], [[MS]], [[Guillian Barre]] | |||
===Correction=== | ===Correction=== | ||
*WBC correction (for bloody tap) | |||
**Simplified version (if peripheral WBC and RBC counts are within normal limits): | |||
***Subtract 1 WBC for every 750 RBC in CSF | |||
**Complex version (WBC and/or RBC not within normal limits): | |||
***"WBCs added" = WBC(blood) x [RBC(CSF) / RBC(blood)] | |||
***WBC counted/resulted - "WBCs added" = actual WBC | |||
*Protein | *Protein | ||
**For each 1000 RBC decrease protein value by 1mg/dl | **For each 1000 RBC decrease protein value by 1mg/dl | ||
Revision as of 21:39, 17 November 2014
| Measure | Normal | Bacterial | Aseptic (Viral) | Fungal | Tuberculosis | Subarachnoid hemorrhage | Neoplastic |
| Appearance | Clear | Clear, cloudy, or purulent | Clear | Clear or opaque | Clear or opaque | Xanthochromia, bloody, or clear | Clear or opaque |
| Opening Pressure (cm H2O) | 10-20 | >25 | Normal or elevated | >25 | >25 | >25 | Normal or elevated |
| WBC Count^ (cells/µL) | 0-5^ | >100^ | 5-1000 | <500 | 50-500 | 0-5 (see correction section) | <500 |
| % PMNs | >80-90% | 1-50%^^ | 1-50% | Early PMN then lymph | 1-50% | ||
| Glucose | >60% of serum glucose | Low | Normal | Low | Low | Normal | Normal |
| Protein^^^ (mg/dL) | < 45 | Elevated | Elevated | Elevated | Elevated | Elevated | >200 |
| Gram Stain | Neg | Pos | Neg | India ink | Tb stain | Blood |
- ^Normal or lower WBC results may be found in immunocompromised, early, or partially treated (e.g. with oral antibiotics) bacterial menintigis, and those with tuberculosis meningitis
- ^^Lymph predominance may be found in patients with early bacterial meningitis or those that have been partially treated (e.g. with oral antibiotics)
- ^^^For unexplained elevations of protein, consider encephalitis, MS, Guillian Barre
Correction
- WBC correction (for bloody tap)
- Simplified version (if peripheral WBC and RBC counts are within normal limits):
- Subtract 1 WBC for every 750 RBC in CSF
- Complex version (WBC and/or RBC not within normal limits):
- "WBCs added" = WBC(blood) x [RBC(CSF) / RBC(blood)]
- WBC counted/resulted - "WBCs added" = actual WBC
- Simplified version (if peripheral WBC and RBC counts are within normal limits):
- Protein
- For each 1000 RBC decrease protein value by 1mg/dl