Treatments & Therapies

Brain water examination – treatment, effect and risks

Cerebrospinal fluid examination

During a cerebrospinal fluid examination, cerebrospinal fluid is removed from the spinal cord canal, usually by means of a lumbar puncture, and then examined. The analysis of the cerebrospinal fluid provides valuable diagnostic information compared to the blood values .

What is a cerebrospinal fluid test?

During the cerebrospinal fluid examination , also known as a liquor puncture or lumbar puncture , nerve fluid (liquor cerebrospinalis) is taken from the dural sac in the spinal cord canal .

The puncture of the dural sac is the simplest and most common form of removing liquor and is carried out with the help of an eight to ten centimeter long needle. As a rule, the cerebrospinal fluid examination is carried out on an outpatient basis and does not require an inpatient stay.

If it is not possible to remove the cerebrospinal fluid from the dural sac, for example due to tumors, a cistern puncture can be carried out and the cerebrospinal fluid can be removed at the level of the first cervical vertebra, or a ventricular puncture, in which the liquor is taken from the cerebral ventricle, a cavity in the brain filled with liquor , is taken directly.

Function, effect & goals

The cerebrospinal fluid examination is carried out, among other things, to diagnose or rule out diseases of the nervous system or the meninges , such as meningitis , encephalitis , borreliosis , neurosyphilis or multiple sclerosis . In addition, important information about possible cancer, such as a brain tumor , can also be obtained.

Cancer of the meninges in an advanced stage, for example in the case of leukemia or lymphoma , can also be detected in the cerebrospinal fluid. A subarachnoid hemorrhage, a special form of stroke in which blood enters the subarachnoid space, can be detected by a cerebrospinal fluid test, since the blood is detectable in the cerebrospinal fluid.

The lumbar puncture is performed while sitting or lying down, with the upper body bent over. If desired, the procedure can be performed under local anesthesia. The necessary tests are then carried out in the laboratory.

An initial diagnosis can often be made with a simple visual inspection. Normally, the CSF is clear as water, but with a bacterial infection it tends to be whitish and cloudy, which is influenced by the high number of leukocytes in the CSF. More recent bleeding can be seen in the cerebrospinal fluid as a reddish cloudiness. A yellowish cloudiness of the cerebrospinal fluid occurs with older bleeding or with purulent processes, such as purulent meningitis.

Among other things, markers can be determined for:

1. Bacteria

2. Mushrooms

3. Leukocytes

4. Liquor Sugar

5. Immunoglobulins

6. Enzymes

7. Electrolytes

Since there is almost no exchange between blood and cerebrospinal fluid due to the blood-cerebrospinal fluid barrier in the body, components of the blood can pass into the cerebrospinal fluid in some diseases. Therefore, the liquor is normally always compared with the blood values, as this is the only way to correctly assess the cerebrospinal fluid.

For example, if there are antibodies (immunoglobulins) in the liquor, this can indicate a disruption in the blood-liquor barrier, such as in multiple sclerosis, or be caused by the formation of immune cells in the liquor itself. To find out where the cause is a comparison of the immunoglobulins in the blood is used.

Protein in the liquor can also be caused by a disruption in the blood-liquor barrier. However, bleeding into the cerebrospinal fluid or inflammation can also lead to an increased protein concentration.

A comparison between the glucose concentration in the liquor and the blood sugar also provides indications of a disruption in the blood-liquor barrier. Normally, the glucose value in the liquor is about half as high as that in the blood. An elevated value in the liquor indicates a disruption in the blood-liquor barrier, while a value that is too low indicates inflammatory processes.

And the number of cells in the liquor also provides information on a possible disease. Normally, the cerebrospinal fluid contains only 4 cells per microliter. However, if there are infections in the nervous system, then the number of cells increases. The type of infection, whether bacterial or viral, can also be determined from the cell type in the CSF.

Risks, side effects & dangers

Lumbar punctures are not always without complications. The greatest danger in a cerebrospinal fluid examination is increased intracranial pressure , since the cerebrospinal fluid can be crushed, which can result in bleeding . Therefore, prior to a lumbar puncture, elevated intracranial pressure must be ruled out using computed tomography .

Patients with a blood clotting disorder, even if this is of a medicinal nature, for example by taking aspirin , must also not be punctured.

During the cerebrospinal fluid collection, you may experience a temporary pain in your buttocks, hips, or legs if the needle touches a nerve root. However, the pain usually subsides fairly quickly. In the days after the lumbar puncture, so-called post-puncture headaches often occur , which can be accompanied by severe nausea and dizziness . In general, this decreases when lying down and has subsided after a few days. In rare cases, the headache can also last up to 4 weeks during a cerebrospinal fluid examination.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.