Cerebral Spinal Fluid (CSF) Test: Procedure, Purpose, Results, Normal values, Cost, Price, Online booking

What Is a Cerebral Spinal Fluid (CSF) Test?
CSF is the watery fluid present around the brain and spinal cord. It functions as a protective shock absorber around these delicate organs, carries glucose, oxygen and ions and chemicals to the brain cells, and helps maintain the pH of blood. CSF also aids in the transportation of hormones, ions, proteins, enzymes from the brain and spinal cord.
A CSF test involves analysis of the levels of different chemicals and cells in the cerebral spinal fluid for the diagnosis of various diseases. The CSF for testing is extracted from the patient through a procedure called lumbar puncture (LP) or spinal paracentesis. An LP is done in the area of the lower back. If needed, it can sometimes also be taken from other parts around the brain and spinal cord.
A CSF test has now become an important part of the diagnosis of various conditions because it can help them decide further tests to be performed.The test is sometimes referred to as spinal tap, CSF culture, ventricular puncture or cisternal puncture.

Why is a Cerebral Spinal Fluid (CSF) test performed?
How do you prepare for a Cerebral Spinal Fluid (CSF) test?
How is a Cerebral Spinal Fluid (CSF) test performed?
Cerebral Spinal Fluid (CSF) test results and normal values

Why is a Cerebral Spinal Fluid (CSF) test performed?

CSF test is mainly done to microscopically look for the presence of any infections or abnormal cells or to analyse proteins and chemicals in the body. A change in the levels of any substance could indicate an underlying condition. Therefore, a doctor may recommend a CSF test in the following cases:

Unexplained seizures
Fevers of unidentified origin
Dementia (Memory loss)
Acute confusion states
Inhalation of anthrax
Encephalitis
Suspected tumours

The physical appearance and pressure while collecting the sample can also be an indication of certain disorders.

A CSF test can identify specific bacteria, viruses, brain-specific proteins and markers for inflammation and cancers. Thus, the doctor could perform a CSF test as a part of diagnosis for any of the following underlying conditions:

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How do you prepare for a Cerebral Spinal Fluid (CSF) test?

This test does not require special preparations. Make sure you are well-rested before the test and available for an entire day for the procedure, as proper rest is essential after the procedure. Also, it is important that you inform your doctor about any previous medical conditions you may have had or if you are taking any medicines or herbal supplements.

How is a Cerebral Spinal Fluid (CSF) test performed?

At the test centre, your doctor will first explain the basic procedure to you. The following steps will then be followed for the test:

You will be asked to lie down on the bed on one side and curl up in a foetal position with your legs close to your chest
Your doctor will clean the area of puncture, ie on the lower back between two bones (vertebrae), to make it sterile and he/she will apply a numbing cream
A sterilised needle will then be slowly inserted between two bones to collect the fluid
The doctor will use a manometer to check the pressure of the fluid at this point
Once the fluid is withdrawn, the needle will be slowly removed
The area will be covered with a cotton gauze and bandage
You will be asked to remain in the foetal position for some time and take rest for a few hours

A slight tingling sensation may be felt due to the numbing cream applied on the lower back. You might also have a headache after the procedure, which may last several hours. Inform the doctor if the headache prolongs.

If you feel nauseated, your doctor may advise you to stay on intravenous fluids. In extremely rare cases, there could be a chance of infection due to the procedure. The doctor will recommend antibiotics accordingly.
It is essential that you remain calm throughout the test. Lying in the foetal position for long may be uncomfortable, but if you do not move, the procedure will be completed in approximately 30 minutes.

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Cerebral Spinal Fluid (CSF) test results and normal values

Normal results: The following values would indicate normal results:

Pressure	8-20 centimetres (cm) H₂O
Appearance	Clear and colourless water-like
Protein	15-60 milligrams (mg)/100 millilitres (mL)
Glucose	50-80 mg/100 mL (or greater than 2/3 of blood sugar level taken simultaneously)
Glutamine	6-15 mg/decilitres (dL)
Lactate dehydrogenase	less than 2.0-7.2 units (U)/mL
White blood cells (WBCs)	0-4/ cubic millimetres (mm3)
Chloride	110-125 milliequivalents (mEq)/litre (L)

Abnormal results: Values outside the normal range are indicative of an underlying condition. The following table gives a detailed list of conditions that could be associated with abnormal results.

Pressure	Increased	Increased pressure in the skull
Pressure	Decreased	Tumour in the spinal cord, diabetic coma
Appearance	Cloudy	Presence of infections, WBCs or proteins
	Bloody	Bleeding or obstruction in the spinal cord
	Brown, yellow, orange	Signs of previous bleeding
Protein	Increased	Breakdown of the blood-brain barrier and infections due to bacteria, virus or fungus
Protein	Decreased	Excess CSF production
Glucose	Decreased	Bacterial infection or fungal infection leading to meningitis, tuberculosis
Glucose	Increased	High blood sugar
WBCs	Increased	Bacterial and viral infections, tumours, multiple sclerosis, stroke or abscess

Presence of specific strains of bacteria and virus could be indicative of the specific disease
Presence of cancerous cells is similarly an indication of the specific type of cancer
Presence of red blood cells is an indication of a traumatic LP process
Presence of antibodies could be an indication of diseases like Guillain-Barre syndrome, multiple sclerosis or even neurosyphilis
Other diseases that could also be indicated by the CSF test are encephalitis, Alzheimer’s, hepatic encephalopathy, Reye syndrome and amyotrophic lateral sclerosis (ALS).

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

Gerard J. Tortora, Bryan Derrickson. Cerebrospinal fluid 14th ed. U.S: Wiley Publication; 2014. Chapter 14, pp 477-478
American Family Physician. [Internet] . American Academy of Family Physicians. U.S Cerebrospinal fluid
Nicklaus Children Hospital. [Internet]. U.S Cerebral spinal fluid (CSF) collection
Jurado R, Walker HK. Clinical Methods: The History, Physical, and Laboratory Examinations 3rd edition. Boston: Butterworths; 1990. Chapter 74
William J. Marshall, S. K. Bangert. Clinical Biochemistry: Metabolic and Clinical Aspects 3rd Edition London : Elsevier Publishing 2014, Page no: 660-672
UCSF health: University of California [internet]; CSF Chemistry
Provan D.Oxford Handbook of Clinical and Laboratory Investigation 4th ed. United Kingdom: Oxford University Press; 2018. Page no: 418.