Lumbar puncture and CSF analysis
When to do a lumbar puncture and when to delay it, reading CSF in order (pressure, cells, protein, glucose, lactate), traumatic taps and xanthochromia, oligoclonal bands, albuminocytological dissociation, dementia biomarkers and RT-QuIC, CSF in delirium, and post-dural puncture headache.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Do the LP for a question CSF can answer: infection, SAH after 6 hours, inflammation, malignancy, pressure, or dementia biomarkers.
- Delay it for signs of raised pressure or mass effect until imaging is done, and for coagulopathy or active anticoagulation. In suspected bacterial meningitis, treat first.
- Read CSF in a fixed order: pressure, appearance, cells, protein, glucose ratio, lactate, microbiology, special tests.
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Sources
- Therapeutic Guidelines: Antibiotic. Central nervous system infections (meningitis, encephalitis, brain abscess)AU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition (topic version not verified)
- Therapeutic Guidelines: NeurologyAU/NZTherapeutic Guidelines Limited
- Delirium Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2021
- Creutzfeldt-Jakob disease (CJD): notification and the Australian National CJD RegistryAU/NZAustralian Government Department of Health, Disability and Ageing
- Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management (NG240)National Institute for Health and Care Excellence, 2024
- Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group (Uppal V et al. Reg Anesth Pain Med 2024;49:471-501)Regional Anesthesia and Pain Medicine, 2024 (summary in JAMA Netw Open 2023)
- Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines, fifth edition (Kopp SL et al.)Regional Anesthesia and Pain Medicine, fifth edition (online 2025, print 2026)
- Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteriaMontalban X et al., Lancet Neurology 2025;24(10):850-865, 2024 (published 2025)
- Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis (Nath S et al. Lancet 2018;391:1197-204)The Lancet, 2018
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy