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Table 3 Steps of CSF analysis

From: S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Analytical stepParametersIndication/Remarks
Emergency analysisAppearance (if contaminated with blood, 3-tubes test), cell count, total protein, lactateAcute inflammation, bacterial or viral, cerebral bleeding (SAH, ICH)
Basic analysisQuotients Albumin, IgG, IgA, IgM, and oligoclonal bandsIntrathecal inflammation, Blood-CSF barrier function
Differential cell countDifferentiation of inflammation, bleeding, and neoplastic involvement
Gram staining and culturePathogen detection (bacteria, fungi)
Extended analysisPathogen-specific antibody (Antibody index)Infection or autoimmune disease
CNS-specific proteinsNeurodegenerative diseases (AD, CJD, ALS, Narcolepsy, etc.)
Immune cytology, tumor markersTumor: confirmation and subtyping
Antigen detectionPathogen detection (bacteria, fungi)
PCRStandard for viruses and Tbc, some other bacteria and parasitesa
  1. AD Alzheimer’s disease, ALS amyotrophic lateral sclerosis, CJD Creutzfeldt-Jakob disease, ICH intracerebral hemorrhage, SAH subarachnoid hemorrhage, Tbc tuberculosis
  2. a e.g., if findings from staining and antigen detection are negative