Guidelines
Lumbar Puncture

Lumbar Puncture

Instructions

Record opening pressure & CSF appearance

Send for cell count with differential, glucose, protein, gram stain and bacterial cultures

For suspected viral meningitis, add PCR for HSV 1/2, VZV and Enterovirus

For aseptic meningitis: add fungal culture, serum, CSF cryptococcal antigen, and syphilis EIA

CSF Minimum

Tube 1: Chemistry Tube 2: Micro/Virology Tube 3: Haematology Tube 4: Save for other studies

CSF Characteristics

Appearance: Clear WBC: 0-5/mcgL Predominant cell type: n/a Protein: 0.15-0.5 g/L Glucose: 2.5-4.5 mmol

Appearance: Turbid WBC: ↑↑↑ Predominant cell type: Neutrophils Protein: ↑↑ Glucose ↓↓

Appearance: Clear WBC: ↑ Predominant cell type: Lymphocytes Protein: Normal or mild elevation Glucose ↓

Note

CSF profile may not be typical of bacterial infection in case of partially treated meningitis

Add Acyclovir if CSF profile is compatible with viral meningitis

PCR of CSF can be negative initially in the course of HSV infection. Repeat LP if clinical presentation is consistent with HSV meningoencephalitis