Lumbar Puncture Lab Tests

  • Author: Gil Z Shlamovitz, MD; Chief Editor: Helmi L Lutsep, MD   more...
 
Updated: May 8, 2012
 

Lab Test Summary

Different institutions have different protocols for the studies performed on the cerebrospinal fluid. Typical studies include the following:

  • Cell count and differential
  • Glucose and protein levels
  • Gram stain, culture and sensitivity (C&S)

When indicated, viral titers or cultures, Venereal Disease Research Laboratory (VDRL) tests, Cryptococcus antigen assays, India ink stains, angiotensin-converting enzyme (ACE) levels, or other studies may also be ordered. Additional tests may be warranted, depending on the clinical situation.

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Cytologic Studies

A larger-than-usual number of white blood cells (WBCs) suggests an infection or, more rarely, leukemic infiltration. In addition, inflammation from any source can raise the WBC count. A traumatic tap, of course, introduces WBCs and red blood cells (RBCs) into the CSF. An approximation of 1 WBC for every 1000 RBCs can be made, though a repeat tap may be preferable. Although no normal value for RBCs in the CSF is known, an occasional RBC may be incident to the tap itself.

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Protein Assessment

Assessment of CSF protein level, though nonspecific, can be a clue to otherwise unsuspected neurologic disease. The high protein levels in demyelinating polyneuropathies, or postinfectious states, can be informative. A traumatic tap can introduce protein into the CSF. An approximation of 1 mg of protein for every 750 RBCs may be used, but a repeat tap is preferable.

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Glucose Assessment

The CSF glucose level normally approximates 60% of the peripheral blood glucose level at the time of the tap. A simultaneous measurement of blood glucose (especially if the CSF glucose level is likely to be low) is recommended. A low CSF glucose level is usually associated with bacterial infection but is also seen in tumor infiltration. A high CSF glucose level has no specific diagnostic significance and is most often spillover from an elevated blood glucose level.

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Contributor Information and Disclosures
Author

Gil Z Shlamovitz, MD  Assistant Professor, Section of Emergency Medicine, Baylor College of Medicine; Director of Medical Informatics, Emergency Center, Ben Taub General Hospital

Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Nirav R Shah, MD, MPH  Commissioner, New York State Department of Health

Nirav R Shah, MD, MPH is a member of the following medical societies: American College of Physicians, New York Academy of Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD  Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, Oregon Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association

Disclosure: Co-Axia Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

Additional Contributors

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.

References

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Lumbar puncture disposable tray. Image courtesy of Gil Z Shlamovitz, MD.
Lumbar puncture lateral recumbent position. Image courtesy of Gil Z Shlamovitz, MD.
Lumbar puncture sitting position. Image courtesy of Gil Z Shlamovitz, MD.
L3-L4 interspace palpation. Image courtesy of Gil Z Shlamovitz, MD.
CSF collection tubes. Image courtesy of Gil Z Shlamovitz, MD.
Skin preparation. Video courtesy of Gil Z Shlamovitz, MD.
Drape application. Video courtesy of Gil Z Shlamovitz, MD.
Local anesthesia. Video courtesy of Gil Z Shlamovitz, MD.
Spinal needle insertion. Video courtesy of Gil Z Shlamovitz, MD.
Spinal needle removal. Video courtesy of Gil Z Shlamovitz, MD.
Opening pressure measurement. Video courtesy of Gil Z Shlamovitz, MD.
 
 
 
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