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Table 3 Steps of CSF analysis

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

Analytical step Parameters Indication/Remarks
Emergency analysis Appearance (if contaminated with blood, 3-tubes test), cell count, total protein, lactate Acute inflammation, bacterial or viral, cerebral bleeding (SAH, ICH)
Basic analysis Quotients Albumin, IgG, IgA, IgM, and oligoclonal bands Intrathecal inflammation, Blood-CSF barrier function
Differential cell count Differentiation of inflammation, bleeding, and neoplastic involvement
Gram staining and culture Pathogen detection (bacteria, fungi)
Extended analysis Pathogen-specific antibody (Antibody index) Infection or autoimmune disease
CNS-specific proteins Neurodegenerative diseases (AD, CJD, ALS, Narcolepsy, etc.)
Immune cytology, tumor markers Tumor: confirmation and subtyping
Antigen detection Pathogen detection (bacteria, fungi)
PCR Standard 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