Cytological examination of cerebrospinal fluid

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Cytological examination of cerebrospinal fluid is part of the basic examination of cerebrospinal fluid. It contributes to the diagnosis of neuroinfections, bleeding into CNS, autoimmune diseases, or tumors. It includes:

  1. quantitative cytology - consists in determining the number of cellular elements
  2. qualitative cytology - cell types in cerebrospinal fluid and their number are determined

Method of determination[edit | edit source]

  • Native non-centrifuged cerebrospinal fluid should be used for cytological examination and counting of cells should be initiated within 3 hours of collection (0.1 ml is sufficient). Stained with acid fuchsin.
  • Cells are counted in a Fuchs-Rosenthal chamber, which has a volume of approximately 3 mm3. Therefore, the results are expressed as a fraction of n/3.
  • Erythrocytes are counted in the unstained specimen, while the other cells are counted in the stained specimen.

Rating[edit | edit source]

  • We find up to 10/3 (3 in 1 ml) cells in the cerebrospinal fluid of a healthy adult, and the the value 11–15/3 is considered borderline high. The normal number of cells is referred to as oligocytosis. When the number of cells is elevated, we speak of pleocytosis.
  • In regards to qualitative evaluation, only lymphocytes (60-80%) and monocytes (20-40%) are present in the normal cerebrospinal fluid, and rarely ependymal cells or choroid plexus cells are present.
  • The presence of erythrocytes may be due to an injury to the vessel during lumbar puncture or as a result of bleeding into the cerebrospinal fluid.
  • The presence of other elements (granulocytes, activated lymphocytes, plasma cells, activated monocytes, tumor cells) is a symptom of pathological processes in the CNS.

Some types of pathological cytological findings in cerebrospinal fluid[edit | edit source]

Pleocytosis[edit | edit source]

  • Monocytic
Monocyte cells predominate and their activated forms are elevated. They represent a non-specific reaction to previous irritation of the nervous system (e.g., CNS ischemia, terminal phase of inflammation with a clearing reaction, condition after CNS angiography).
  • Granulocytic
A marked increase in neutrophilic granulocytes (thousands to tens of thousands) is typical of purulent (bacterial) inflammation. The predominance of eosinophils occurs in allergic reactions or in some neuroinfections (parasitic, fungal).
  • Lymphocytic
Pleocytosis with a predominance of lymphocytes, including activated forms, is a characteristic finding for non-purulent inflammatory diseases of viral origin, but sometimes in some bacterial neuroinfections.

Pathological oligocytosis[edit | edit source]

(the total number of elements does not exceed the norm, but the ratios of different cell populations is abnormal)

  • Monocytic
It is characterized by a predominance of monocytes and an increased relative proportion of activated monocytes. This non-specific pattern may be accompanied, for example, by bleeding into the cerebrospinal fluid with erythrocytes phagocytosed by macrophages, or a terminal phase of inflammation.
  • Granulocytic
Granulocyte oligocytosis with a predominance of neutrophils is a common finding in incipient purulent and non-purulent neuroinfections.
  • Lymphocytic
It is characterized by a predominance of lymphocytes with an increased relative proportion of activated forms. The presence of plasma cells indicates intrathecal antibody synthesis. It is typical of chronic neuroinfections and for multiple sclerosis.
  • Tumorous pleocytosis or oligocytosis
Tumor cells in the cerebrospinal fluid originate in tumors located near the cerebrospinal fluid pathways or in the malignant infiltration of the meninges.

References[edit | edit source]

Related Articles[edit | edit source]

External links[edit | edit source]

  • FIALOVÁ, L. a M VEJRAŽKA. Základní vyšetření mozkomíšního moku [online]. ©2005. Poslední revize 2008, [cit. 16.2. 2022]. <>.

Literature[edit | edit source]

  • ADAM, P, et al. Cytologie mozkomíšního moku (CD-ROM). 1. vydání. Praha : SEKK, 2000. 
  • AMBLER, Z, J BEDNAŘÍK a E RŮŽIČKA. Klinická neurologie – část obecná. 1. vydání. Praha : Triton, 2004. ISBN 80-7254-556-6.
  • GLOSOVÁ, L. Cytologický atlas mozkomíšního moku. 1. vydání. Praha : Galén, 1998. ISBN 80-85824-70-1.
  • KALA, M. a J MAREŠ. Lumbální punkce a mozkomíšní mok. 1. vydání. Praha : Galén, 2008. ISBN 978-80-7262-568-0.
  • MASOPUST, J. Klinická biochemie. Požadování a hodnocení biochemických vyšetření I. a II. část. 1. vydání. Praha : Karolinum, 1998. ISBN 80-7184-650-3.
  • NEVŠÍMALOVÁ, S, E RŮŽIČKA a J TICHÝ, et al. Neurologie. 1. vydání. Praha : Galén, 2005. ISBN 80-7262-160-2.
  • SCHNEIDERKA, Petr, et al. Kapitoly z klinické biochemie. 2. vydání. Praha : Karolinum, 2004. ISBN 80-246-0678-X.
  • RACEK, J, et al. Klinická biochemie. První vydání. Praha : Galén – Karolinum, 1999. s. 317. ISBN 80-7262-023-1.
  • ŠTERN, P, et al. Obecná a klinická biochemie pro bakalářské obory studia. 1. vydání. Praha : Karolinum, 2005. ISBN 978-80-246-1025-2.
  • ZIMA, T, et al. Laboratorní diagnostika. 1. vydání. Praha : Galén – Karolinum, 2002. s. 728. ISBN 80-7262-201-3.