Subarachnoid haemorrhage (SAH), or puncture of a blood vessel by the needle, may account for blood stained CSF. To differentiate, collect CSF in three bottles.
Uniformly stained = SAH
CSF clears in 3rd bottle = traumatic tap
In practice, doubt may remain - also look for xanthochromia (naked eye and spectrophotometry)
Check that the patient's head (foramen of Munro) is level with the lumbar puncture. Connect a manometer via a 3-way tap to the needle and allow CSF to run up the column. Read off the height. Normal value: 100-150 mm CSF.
1. Bacteriological - RBC and differential WBC (normal = < 5 WBCs per mm3]
- Gram stain and culture
- appearance of supernatant. Xanthochromia (yellow staining) results from subarachnoid haemorrhage with RBC breakdown, high CSF protein or jaundice.
- glucose (normal = 0.45-0.70 g/1) 40-60% of blood glucose simultaneously sampled.
Special tests Suspected:
Malignant tumour - cytology
Tubercle - Ziehl-Neelson stain, Lowenstein-Jensen culture
Non-bacterial infection - virology, fungal and parasitic studies Demyelinating disease - oligoclonal bands
Neurosyphilis - VDRL (Venereal Disease Research Laboratory) test
- FTA-ABS (Fluorescent treponemal antibody absorption) test
- Treponema pallidum immobilisation test (TPI) Cryptococcus - culture and antigen detection
HIV - culture, antigen detection and antiviral antibodies (anti-HIV-IgG).
- tonsillar herniation (see page 77)
- transient headache (10%), radicular pain (10%), or ocular palsy (1%)
- epidural haemorrhage very rare.
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