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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