Reference — Neurology
Meningitis CSF & Lumbar Puncture Reference
The lumbar puncture tells you which meningitis you’re facing. The one pattern to lock in: bacterial = cloudy, high protein, LOW glucose; viral = clear, normal glucose.
Educational use only. CSF interpretation is provider-directed and read in clinical context; LP is a provider-performed procedure. This reference is an educational aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
CSF Patterns by Cause
| Parameter | Bacterial | Viral | Fungal |
|---|---|---|---|
| Appearance | Cloudy / turbid | Clear | Clear or cloudy |
| WBCs | Very high — neutrophils | High — lymphocytes | High — lymphocytes |
| Protein | HIGH | Normal to mildly high | High |
| Glucose | LOW | NORMAL | Low |
| Opening pressure | Elevated | Normal/slightly elevated | Elevated |
Memory aid: bacteria eat the glucose → low CSF glucose, and the pus makes it cloudy with high protein and neutrophils.
Meningeal Signs
Nuchal rigidity: stiff, painful resistance to neck flexion. Kernig’s sign: with the hip flexed 90°, extending the knee causes pain/resistance. Brudzinski’s sign: passive neck flexion causes involuntary hip and knee flexion. These reflect meningeal irritation and support (but don’t confirm) the diagnosis.
Lumbar Puncture Nursing Care
Before: verify consent; have the patient empty the bladder; position in the lateral recumbent “fetal” position (knees to chest) or sitting and leaning forward to open the intervertebral spaces. During: help the patient hold still and breathe normally; provide reassurance. After: the patient typically lies flat and is encouraged to increase fluids to reduce a post-LP (spinal) headache; monitor the site, neuro status, and for headache or leakage. Do not delay antibiotics waiting for the LP in suspected bacterial meningitis.
NCLEX Pearls
- ✦Bacterial CSF: cloudy, ↑neutrophils, ↑protein, LOW glucose, ↑pressure; viral: clear, lymphocytes, NORMAL glucose.
- ✦Bacteria eat glucose → low CSF glucose is the bacterial hallmark.
- ✦Kernig's (knee extension pain with hip flexed) and Brudzinski's (neck flexion → hip/knee flexion) = meningeal irritation.
- ✦LP position: lateral fetal (knees to chest) or sitting leaning forward.
- ✦Post-LP: bed rest and extra fluids are common comfort measures, but current evidence (Cochrane) shows bed rest does NOT prevent the spinal/post-dural-puncture headache (and may increase it); treatment when it occurs is analgesia/caffeine, with an epidural blood patch for refractory cases.
- ✦Never delay antibiotics for the LP in suspected bacterial meningitis.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Heart Association / American Stroke Association (AHA/ASA) · American Association of Neuroscience Nurses (AANN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →