CSF coccidioides complement fixation test

Coccidioides antibody test – spinal fluidCSF coccidioides complement fixation is a test that checks for infection due to the fungus Coccidioides in the cerebrospinal (CSF) fluid. This is the fluid surrounding the brain and spine. The name of this infection is coccidioidomycosis, or valley fever.

This test can also be done as a blood test .

How the Test is Performed

A sample of spinal fluid is needed for this test. The sample is usually obtained by lumbar puncture (spinal tap).

The sample is sent to a laboratory. There, it is examined for Coccidioides antibodies using a laboratory method called complement fixation. This technique checks if your body has produced substances called antibodies to a specific foreign substance (antigen), in this case Coccidioides .

Antibodies defend your body against bacteria, viruses, and fungi. If the antibodies are present, they stick, or “fix” themselves, to the antigen. This is why the test is called “fixation.”

How to Prepare for the Test

Follow your health care provider’s instructions on how to prepare for the test. Expect to be in the hospital for several hours afterward.

During the test:

• You lie on your side with knees pulled up toward your chest and chin tucked downward. Or, you sit up, but bent forward.
• After your back is cleaned, the doctor injects a local numbing medicine (anesthetic) into your lower spine.
• A spinal needle is inserted, usually into the lower back area.
• Once the needle is properly positioned, CSF pressure is measured and a sample is collected.
• The needle is removed, the area is cleaned, and a bandage is placed over the needle site.
• You are taken to a recovery area where you rest for several hours to prevent any CSF leakage.

Why the Test is Performed

This test checks if your central nervous system has an active infection from Coccidioides .

Normal Results

The absence of fungus (a negative test) is normal.

What Abnormal Results Mean

If the test is positive for fungus, there may be an active infection in the central nervous system.

An abnormal spinal fluid test means that the central nervous system is infected. But an abnormal blood test does not pinpoint the exact area of infection. It only means that there is a coccidioides infection somewhere in the body.

During the early stage of an illness, few antibodies may be detected. Antibody production increases during the course of an infection. For this reason, this test may be repeated several weeks after the first test.

Risks

Risks of lumbar puncture include:

• Bleeding into the spinal canal
• Discomfort during the test
• Headache after the test
• Hypersensitivity (allergic) reaction to the anesthetic
• Infection introduced by the needle going through the skin
• Damage to the nerves in the spinal cord, especially if the person moves during the test

Cerebrospinal fluid (CSF) culture

Culture – CSF; Spinal fluid culture; CSF culture

A cerebrospinal fluid (CSF) culture is a laboratory test to look for bacteria, fungi, and viruses in the fluid that moves in the space around the spinal cord. CSF protects the brain and spinal cord from injury.

How the Test is Performed

A sample of CSF is needed. This sample is usually done with a lumbar puncture, or a spinal tap .

The sample is sent to the laboratory. There, it is placed in a special dish called a culture medium. Laboratory staff then observe if bacteria, fungi, or viruses grow in the dish. Growth means there is an infection.

How to Prepare for the Test

Follow instructions on how to prepare for a spinal tap .

Why the Test is Performed

Your health care provider may order this test if you have signs of an infection that affects the brain or nervous system. The test helps identify what is causing the infection. This will help your provider decide on the best treatment.

Normal Results

A normal result means no bacteria, viruses, or fungi grew in the laboratory dish. This is called a negative result. However, a normal result doesn’t mean that there is no infection. The spinal tap and CSF smear may need to be done again.

What Abnormal Results Mean

Bacteria or other germs found in the sample may be a sign of meningitis. This is an infection of the membranes covering the brain and spinal cord. The infection can be caused by bacteria , fungi, or viruses.

Risks

A laboratory culture poses no risk to you. Your provider will tell you about the risks of a spinal tap.

Radionuclide stereogram

CSF flow scan; Cisternogram

A radionuclide stereogram is a nuclear scan test. It is used to diagnose problems with the flow of spinal fluid.

How the Test is Performed

A spinal tap ( lumbar puncture ) is done first. Small amounts of radioactive material, called a radioisotope, are injected into the fluid within the spine.

You will then be scanned 4 to 6 hours after getting the injection. A special camera takes images that show how the radioactive materials travel with the cerebrospinal fluid through the spine. The images also show if the fluid leaks outside the spine or brain.

You will be scanned again 24 hours after injection. You may need additional scans possibly at 48 and 72 hours after injection.

How to Prepare for the Test

Most of the time, you do not need to prepare for this test. Your health care provider may give you a medicine to calm your nerves if you are very anxious. You will sign a consent form before the test.

You will wear a hospital gown during the scan so the doctors have access to your spine. You will also need to remove jewelry or metallic objects before the scan.

How the Test will Feel

Numbing medicine will be put on your lower back before the lumbar puncture. However, many people find lumbar puncture somewhat uncomfortable. This is often due to the pressure on the spine when the needle is inserted.

The scan is painless, although the table may be cold or hard. No discomfort is produced by the radioisotope or the scanner.

Why the Test is Performed

The test is performed to detect problems with flow of spinal fluid and spinal fluid leaks. In some cases, there may be a concern the CSF fluid is leaking after a trauma to the head or a surgery in the head. This test will be done to diagnose the leak.

Normal Results

A normal value indicates normal circulation of CSF through all parts of the brain and spinal cord.

What Abnormal Results Mean

An abnormal result indicates disorders of CSF circulation. These disorders may include:

• Hydrocephalus or dilated spaces in your brain due to an obstruction
• CSF leak
• Normal pressure hydrocephalus (NPH)
• Whether or not a CSF shunt is open or blocked

Risks

Risks associated with a lumbar puncture include pain at the injection site, bleeding, and infection. There is also a very rare chance of nerve damage.

The amount of radiation used during the nuclear scan is very small. Almost all of the radiation is gone within a few days. There are no known cases of the radioisotope causing harm to the person getting the scan. However, as with any radiation exposure, caution is advised if you are pregnant or breastfeeding.

Very rarely, a person may have an allergic reaction to the radioisotope used during the scan. This may include a serious anaphylactic reaction .

Considerations

You should lie flat after the lumbar puncture. This can help prevent headache from the lumbar puncture. No other special care is necessary.

CSF glucose test

Glucose test – CSF; Cerebrospinal fluid glucose test

A CSF glucose test measures the amount of sugar (glucose) in the cerebrospinal fluid (CSF). CSF is a clear fluid that flows in the space surrounding the spinal cord and brain.

How the Test is Performed

A sample of CSF is needed. A lumbar puncture, also called a spinal tap, is the most common way to collect this sample. For information on this procedure, see the article on lumbar puncture .

Other methods for collecting CSF are rarely used, but may be recommended in some cases. They include:

• Cisternal puncture
• Ventricular puncture
• Removal of CSF from a tube that is already in the CSF, such as a shunt or ventricular drain

The sample is sent to a laboratory for testing.

Why the Test is Performed

This test may be done to diagnose:

• Tumors
• Infections
• Inflammation of the central nervous system
• Delirium
• Other neurological and medical conditions

Normal Results

The glucose level in the CSF should be 50 to 80 mg/100 mL (or greater than 2/3 of the blood sugar level).

Note: Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

Abnormal results include higher and lower glucose levels. Abnormal results may be due to:

• Infection (bacterial or fungus)
• Inflammation of the central nervous system
• Tumor

CSF myelin basic protein

CSF myelin basic protein is a test to measure the level of myelin basic protein (MBP) in the cerebrospinal fluid (CSF).

The CSF is the clear liquid that surrounds the brain and spinal cord.

MBP is found in the material that covers many of your nerves.

How the Test is Performed

A sample of spinal fluid is needed. This is done using a lumbar puncture .

Why the Test is Performed

This test is done to see if myelin is breaking down. Multiple sclerosis is the most common cause for this, but other causes may include:

• Bleeding of the central nervous system
• Central nervous system trauma
• Certain brain diseases (encephalopathies)
• Infection of the central nervous system
• Stroke

Normal Results

In general, there should be less than 4 ng/mL of myelin basic protein in the CSF.

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

Myelin basic protein levels between 4 to 8 ng/mL may be a sign of a chronic breakdown of myelin. It may also indicate recovery from an acute episode of myelin breakdown.

If the myelin basic protein level is greater than 9 ng/mL, myelin is actively breaking down.

CSF oligoclonal banding

Cerebrospinal fluid – immunofixation

CSF oligoclonal banding is a test to look for inflammation-related proteins in the cerebrospinal fluid (CSF). CFS is the clear fluid that flows in the space around the spinal cord and brain.

Oligoclonal bands are proteins called immunoglobulins. The presence of these proteins indicates inflammation of the central nervous system. Oligoclonal bands may be a sign of multiple sclerosis.

How the Test is Performed

A sample of CSF is needed. A lumbar puncture (spinal tap) is the most common way to collect this sample.

Other methods for collecting CSF are rarely used, by may be recommended in some cases. They include:

• Cisternal puncture
• Ventricular puncture
• Removal of CSF from a tube that is already in the CSF, such as a shunt or ventricular drain.

After the sample is taken, it is sent to a lab for testing.

Why the Test is Performed

This test helps support the diagnosis of multiple sclerosis (MS). However, it does not confirm the diagnosis. Oligoclonal bands in the CSF can also be seen in other illnesses.

Normal Results

Normally, one or no bands should be found in the CSF.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

There are two or more bandings found in the CSF and not in the blood. This may be a sign of multiple sclerosis or other inflammation.

Intracranial pressure monitoring

ICP monitoring; CSF pressure monitoring

Intracranial pressure (ICP) monitoring uses a device, placed inside the head. The monitor senses the pressure inside the skull and sends measurements to a recording device.

How the Test is Performed

There are 3 ways to monitor pressure in the skull (intracranial pressure).

INTRAVENTRICULAR CATHETER

The intraventricular catheter is the most accurate monitoring method.

To insert an intraventricular catheter, a hole is drilled through the skull. The catheter is inserted through the brain into the lateral ventricle. This area of the brain contains liquid (cerebrospinal fluid or CSF) that protects the brain and spinal cord.

The intraventricular catheter can also be used to drain fluid out through the catheter.

The catheter may be hard to get into place when the intracranial pressure is high.

SUBDURAL SCREW

This method is used if monitoring needs to be done right away. A hollow screw is inserted through a hole drilled in the skull. It is placed through the membrane that protects the brain and spinal cord (dura mater). This allows the sensor to record from inside the subdural space.

EPIDURAL SENSOR

An epidural sensor is inserted between the skull and dural tissue. The epidural sensor is placed through a hole drilled in the skull. This procedure is less invasive than other methods, but it cannot remove excess CSF.

Lidocaine or another local anesthetic will be injected at the site where the cut will be made. You will most likely get a sedative to help you relax.

• First the area is shaved and cleansed with antiseptic.
• After the area is dry, a surgical cut is made. The skin is pulled back until the skull is seen.
• A drill is then used to cut through the bone.

How to Prepare for the Test

Most of the time, this procedure is done when a person is in the hospital intensive care unit. If you are awake and aware, your health care provider will explain the procedure and the risks. You will have to sign a consent form.

How the Test will Feel

If the procedure is done using general anesthesia , you will be asleep and pain-free. When you wake up, you will feel the normal side effects of anesthesia. You will also have some discomfort from the cut made in your skull.

If the procedure is done under local anesthesia, you will be awake. Numbing medicine will be injected to the place where the cut is to be made. This will feel like a prick on your scalp, like a bee sting. You may feel a tugging sensation as the skin is cut and pulled back. You will hear a drill sound as it cuts through the skull. The amount of time this takes will depend on the type of drill that is used. You will also feel a tugging as the surgeon sutures the skin back together after the procedure.

Your provider may give you mild pain medicines to ease your discomfort. You will not get strong pain medicines, because your provider will want to check for signs of brain function.

Why the Test is Performed

This test is most often done to measure intracranial pressure. It may be done when there is a severe head injury or brain/nervous system disease. It also may be done after surgery to remove a tumor or fix damage to a blood vessel if the surgeon is worried about brain swelling.

High intracranial pressure can be treated by draining CSF through the catheter. It can also be treated by changing the ventilator settings for people who are on a respirator, or by giving certain medicines through a vein (intravenously).

Normal Results

Normally, the ICP ranges from 1 to 20 mm Hg.

Talk to your health care provider about the meaning of your specific test results.

What Abnormal Results Mean

High intracranial pressure means that both nervous system and blood vessel tissues are under pressure. If not treated, this can lead to permanent damage. In some cases, it can be life-threatening.

Risks

Risks from the procedure may include:

• Bleeding
• Brain herniation or injury from the increased pressure
• Damage to the brain tissue
• Inability to find the ventricle and place catheter
• Infection
• Risks of general anesthesia