CSF Total Protein

Spinal fluid
check icon Optimal Result: 5 - 40 mg/dL, or 50 - 400 mg/L.

Protein appears in nearly all body tissues, along with your enzymes, blood, and cerebrospinal fluid (CSF). Healthy CSF has a low amount of protein.‌

- Protein level, opening pressure, and CSF-to-serum glucose ratio vary with age.

- CSF protein concentration is one of the most sensitive indicators of pathology within the CNS. 

- The spinal fluid normally contains very little protein since serum proteins are large molecules that do not cross the blood-brain barrier. Most of the protein that is normally present is albumin.

- CSF protein concentration may rise due to 2 factors: either an increased permeability of the blood brain barrier allowing more protein and higher molecular weight proteins to enter the CSF or proteins may be synthezised within the cerebrospinal canal by inflammatory or other invading cells.

Newborn patients have up to 150 mg per dL (1.5 g per L) of protein. 

The adult range of 18 to 58 mg per dL (0.18 to 0.58 g per L) is reached between six and 12 months of age. 

The physician should know what the normal reference range is for his or her laboratory, because the measurement is somewhat technique-dependent.

References:

Khan S, Bhattal GK, Shah NH, Lascano J, Karki A. Neuroborreliosis with Unusual Presentation: A Case Report. Cureus. 2019 Sep 25;11(9):e5758. doi: 10.7759/cureus.5758. PMID: 31723517; PMCID: PMC6825459.

Safdieh JE. Caution with CSF Protein Levels: When Abnormal May Actually Be Normal. Mayo Clin Proc. 2023 Feb;98(2):220-221. doi: 10.1016/j.mayocp.2022.12.009. PMID: 36737111

What does it mean if your CSF Total Protein result is too high?

Mild protein elevation may be caused by viral meningitis, neurosyphilis, subdural haematoma, cerebral thrombosis, brain tumor, multiple sclerosis (rarely >1.00 g/L)

Moderate or pronounced elevation may be caused by acute bacterial meningitis, tuberculous meningitis, spinal cord tumor, cerebral hemorrhage, Guillain-Barre syndrome.

Potential health issues that may cause more protein in the spinal fluid include:

→ Infections

→ Vasculitis, when your blood vessels become inflamed

→ Inflammation of spinal cord

→ Meningitis, when the fluid and membranes around your brain and spinal cord become inflamed 

→ Intracranial hemorrhages

→ Multiple sclerosis, a disease of the brain and spinal cord where your immune system attacks your body

→ Guillain Barré syndrome 

→ Malignancies

→ Brain tumor

→ Cancer

→ Lyme disease, which is caused by bacteria spread by ticks and can cause fatigue, headache, and fever

Lyme disease can sometimes cause elevated protein levels in cerebrospinal fluid (CSF). This can occur in cases of neuroborreliosis, which is a neurological manifestation of Lyme disease. Neuroborreliosis can lead to various neurological symptoms, and an analysis of CSF can show abnormalities, including increased protein levels.

→ Some endocrine abnormalities

→ Certain medication use

→ and a variety of inflammatory conditions and autoimmune diseases that affect your brain or spinal cord.

Protein concentration is falsely elevated by the presence of RBCs in a traumatic tap situation. This can be corrected by subtracting 1 mg per dL (0.01 g per L) of protein for every 1,000 RBCs per mm3.

Older participants, males, and patients with diabetes are more likely to have higher CSF protein concentration.

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What does it mean if your CSF Total Protein result is too low?

- When CSF protein levels are low it can indicate rapid CSF production.

- Low CSF protein levels can occur in conditions such as repeated lumbar puncture or a chronic leak, in which CSF is lost at a higher than normal rate.

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