Abnormal Cerebrospinal fluid (CSF)

• Cerebrospinal fluid (CSF) shows characteristic findings in various diseases.

The appearance of Abnormal Cerebrospinal fluid

1. Normal, clear, and colorless.
2. Cloudy CSF is due to:
   1. Infection when WBCs are >200 /cmm.
   2. Hemorrhage when RBCs are >400 /cmm
   3. Traumatic tap.
   4. In the case of high proteins in the CSF.
3. Oily CSF is due to the following:
   1. when there are radiographic contrast media in CSF.
4. Yellow CSF is due to:
   1. It is because of the raised level of bilirubin in jaundice.
5. Xanthochromic of CSF:
   1. This color of centrifuged supernatant CSF is because of raised proteins.

Abnormal Cerebrospinal fluid: CSF Xanthochromasia

6. Bloody CSF is due to:
   1. When the RBC count is >600 /cmm and is because of hemorrhage or traumatic tap.
7. The brown color of CSF is due to:
   1. There is the presence of methemoglobin.
8. The pink color of CSF is due to:
   1. There is the presence of oxyhemoglobin.
9. The Orange color of CSF is due to:
   1. It is because of the presence of carotene.
10. Clotted CSF is due to:
    1. It is due to the increased fibrinogen, which will be seen in a traumatic tap. It will be absent in the subarachnoid hemorrhage.

Total cell count in Abnormal Cerebrospinal fluid 

1. Normal values:
   1. RBCs in adult = 0
   2. RBCs in the neonates  = variable
   3. WBCs in adults = < 5 /cmm.
   4. WBCs in neonates = 0 to 30 /cmm.
2. When WBC >1000 /cmm:
   1. It is due to bacterial or fungal infections.
3. When WBCs neonates >100 /cmm:
   1.  It is due to viral meningitis.
4. When RBCs >400 /cmm:
   1. It is due to hemorrhage or traumatic tap.

Differential cell count in Abnormal Cerebrospinal fluid:

Adult Normal cells

1. Lymphocytes = 40% to 80%
2. Monocytes     = 15% to 45%
3.  Neutrophils  = o% to 6%

Newborn Normal cells

1. Lymphocytes  = 5% to 35%
2. Monocytes      = 50% to 90%
3. Neutrophils    = 0% to 8%

Increased neutrophils are due to:

1. Bacterial meningitis.
2. The Early stage of tuberculosis.
3. Cerebral abscess.
4. Tumors.

Increased Lymphocytes are due to:

1. Viral meningitis.
2. Tuberculous meningitis.
3. Multiple sclerosis.
4. Guillain-Barre syndrome.
5. Chronic alcoholism.
6. Drug abuse.
7. Lymphoma.
8. Leukemia.

Increased Monocytes are due to the following:

1. Partial treatment of meningitis.
2. Tumors.
3. Chronic bacterial meningitis.

Increased Eosinophils are due to:

1. Parasitic infestation.
2. Fungal meningitis.
3. Medications.
4. Injection of dyes.
5. Allergic reaction to shunt.

Increased Macrophagic cells are due to:

1. Fungal meningitis.
2. Tuberculous meningitis.
3. Blood contamination.
4. After hemorrhage.

The presence of tumor cells is due to:

1. It is due to infiltration by metastatic carcinoma.

Protein of Cerebrospinal fluid (CSF):

Normal CSF protein = level is 15 to 45 mg/dL

The increased protein level is due to:

1. Bacterial meningitis.
2. Viral meningitis.
3. Increased synthesis of immunoglobulins.
4. Trauma.
5. Cerebral hemorrhage.
6. Contamination by peripheral blood.
7. Due to any obstruction.

The decreased protein level is due to:

1. Loss of fluid due to trauma.
2. Increased reabsorption with increased intracranial pressure.

Glucose level of CSF:

The normal = 50 to 80 mg/dL.

Increased glucose level is due to:

1. In diabetic patients with hyperglycemia.
2. Traumatic puncture.
3. Contamination with peripheral blood.

Decreased level of glucose is due to:

1. In diabetic patients with hypoglycemia.
2. Meningitis.
3. Tumors.
4. In the inflammatory process.

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