Spinal Tap!

No, not the parody English heavy metal band, but the procedure to help identify infectious and auto-immune diseases effecting the central nervous system. Below is a summary of the expected CSF findings in a variety of conditions:

Routine CSF constituents in different CNS disorders
  Normal Viral infection Bacterial infection Fungal infection TB infection GBS Multiple sclerosis
Appearance Clear Clear or opaque Turbid Clear Clear/opaque Clear Clear
White cells (per mm3) 0–5 10–2,000 100–60,000 20–500 50–5,000 Normal >15 atypical (>50 very rare)
Protein (g/l) <0.5 0.5–0.9 >0.9 >0.5 >1.0 >1.0 Normal
Glucose (% serum glucose) >60–75% Normal <40% <80% <50% Normal Normal

Adapted from Clarke et al.

Case Challenge #9

  • History
    • A 52 year old female presents with fever, new-onset weakness, and dyspnea on exertion. This is associated with weight loss and a rash. She denies current or previous drug use. No pets or recent travel.
  • Physical Exam
  • Labs
    • WBC 12k, ESR 75, CRP 8.5.
    • Blood cultures negative ngtd.
  • Imaging
    • Brain MRI shows multifocal acute CVA in different vascular distributions.

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