Liquor parameters in diseases

Xanthochromic coloration (yellow, yellow-gray, yellow-brown, green) appears with jaundice; brain tumors rich in vessels and located close to the cerebrospinal fluid space; cysts; subarachnoid administration of large doses of penicillin; in newborns, such coloration is physiological in nature.

The red color (erythrochromia) is given to the cerebrospinal fluid by unchanged blood, which may appear as a result of trauma or hemorrhage.

Dark cherry or dark brown color is possible with hematomas and the entry of cerebrospinal fluid from cysts.

Turbidity of the cerebrospinal fluid is possible in cases of purulent meningitis, abscess rupture into the subarachnoid space, poliomyelitis, tuberculous and serous meningitis (turbidity appears immediately or after the fluid has stood for 24 hours). Inflammatory processes in the meninges shift the pH to the acidic side.

Increased protein in the cerebrospinal fluid may occur with tuberculous, purulent, serous meningitis, hemodynamic disorders, after brain surgery, with a brain tumor, poliomyelitis, brain injury with subarachnoid hemorrhage, nephritis with uremia. In acute inflammation, a-globulins increase, in chronic inflammation - beta- and y-globulins.

Positive Pandy and Nonne-Apelt reactions indicate an increased content of the globulin fraction and accompany cerebral hemorrhages, brain tumors, meningitis of various origins, progressive paralysis, tabes dorsalis, multiple sclerosis. An admixture of blood to the cerebrospinal fluid always gives positive globulin reactions.

Changes in glucose content in cerebrospinal fluid in various diseases

Increased glucose concentration	Decreased glucose concentration
Encephalitis	Meningitis:
Brain tumors	Tuberculous;
Syphilis of the central nervous system	Streptococcal;
Diabetes mellitus	Meningococcal and others.
Tetany and tetanus (sometimes)	Tumors of the pia mater

Changes in the content of chlorides in cerebrospinal fluid in various diseases

Increased chloride concentration	Decrease in chloride concentration
Brain tumors	Tuberculous and other bacterial meningitis
Abscesses
Echinococcus
Multiple sclerosis
Uremia
Nephritis
Progressive paralysis

Pleocytosis is an increase in the number of cells in the cerebrospinal fluid. Minor pleocytosis is possible with progressive paralysis, syphilis, specific meningitis, arachnoiditis, encephalitis, multiple sclerosis, epilepsy, tumors, spinal and brain trauma. Massive pleocytosis is observed with acute purulent meningitis, abscess.

Lymphocytic pleocytosis is observed in the postoperative period during neurosurgical operations, chronic inflammation of the meninges (tuberculous meningitis, cysticercosis arachnoiditis), viral, syphilitic, fungal meningoencephalitis. Moderate pleocytosis with a predominance of lymphocytes is possible when the pathological process is localized deep in the brain tissue. Unchanged neutrophils are observed when fresh blood enters the cerebrospinal fluid during brain operations, during acute inflammation; changed neutrophils - when the inflammatory process subsides. The combination of unchanged and changed neutrophils indicates an exacerbation of inflammation. A sharp appearance of large neutrophilic pleocytosis is possible when an abscess breaks into the cerebrospinal fluid spaces. In poliomyelitis, neutrophils predominate at the beginning of the disease, followed by lymphocytes.

Changes in cerebrospinal fluid parameters characteristic of bacterial, viral, fungal and tuberculous meningitis

	Type of meningitis
Indicator	Bacterial	Viral	Fungal/ tuberculosis
Number of leukocytes, x10 6 /l	More than 500	Less than 500	Less than 500
Neutrophil content,%	More than 80	Less than 50	Less than 50
Glucose, mmol/l	Less than 2.2	More than 2.2	Less than 2.2
Lactate, mmol/l	More than 4.0	Less than 2.0	More than 2.0
Protein, g/l	More than 1.0	Less than 1.0	More than 1.0

Eosinophils are detected in subarachnoid hemorrhages, toxic, reactive, tuberculous, syphilitic, epidemic meningitis, tumors, and cysticercosis of the brain.

Plasma cells are found in encephalitis, tuberculous meningitis, and slow wound healing after surgery.

Macrophages are detected with normal cytosis after bleeding and during the inflammatory process. A large number of macrophages in the cerebrospinal fluid can be detected during its sanitation in the postoperative period. Their absence in pleocytosis is a poor prognostic sign. Macrophages with fat droplets in the cytoplasm (granular balls) are present in the fluid from brain cysts and in some tumors (craniopharyngioma, ependymoma).

Epithelial cells are found in neoplasms of the membranes, sometimes in inflammatory processes.

Malignant tumor cells can be found in the cerebrospinal fluid of the cerebral ventricles in the case of metastases of cancer and melanoma to the cerebral cortex, subcortical areas, and cerebellum; blast cells - in neuroleukemia.

Erythrocytes appear in the cerebrospinal fluid during intracranial hemorrhages (in this case, it is not so much their absolute number that is important, but rather their increase during repeated examination).