CSF Studies

CSF

tube 1 gs and culture

2 protein glc

3 cell count w diff

4 hold

cryptoccal ag

india ink

afb pcr

rpr vdrl

fungal cx

viral cx

pcr for herpes viridae

ldh >40 suggests bact. Meningitis < 40 viral (neches -pediatrics 1968)

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

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

When to ct before lp

AMS

focal deficit or papilledema

head trauma (recent or remote)

new onset seizure (except poss febrile seizure in child)

HIV+

IVDA only if other above findings are present.

age over 60

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

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.

7/2/09 PANI