CSF Studies

Tests

Standard

1. tube 1 gs and culture
2. 2 protein glc
3. 3 cell count w diff
4. 4 hold

Additional

1. cryptoccal ag
2. india ink
3. afb pcr
4. rpr vdrl
5. fungal cx
6. viral cx
7. pcr for herpes viridae
8. ldh >40 suggests bact. Meningitis < 40 viral (neches -pediatrics 1968)

Correction

for each 1000 rbc dec prot. By 1mg/dl

actual WBC =counted WBC-RBC csfx (Wbc blood/Rbc blood).

When to ct before LP

1. AMS
2. focal deficit or papilledema
3. head trauma (recent or remote)
4. new onset seizure (except poss febrile seizure in child)
5. HIV+
6. IVDA only if other above findings are present.
7. age over 60

When to treat infants under 4-6 weeks empirically for herpes encephalitis:

1. csf pleocytosis consistent w/ encephalitis + 1 of the following:
   1. HSV skin eye or mouth manifest.
   2. focal neuro findings or seizure
   3. sepsis with pneumonitis or hepatitis
   4. mother w/ genital HSV at delivery
   5. consider for very toxic fever >39 EC.

Source

7/2/09 PANI