Green CSF

Case: You encountered green CSF fluid while performing lumbar puncture (LP). What could be the most probable causes?

Answer:  The cerebrospinal fluid (CSF) is produced from arterial blood by the choroid plexuses of the lateral and fourth ventricles by a combined process of diffusion, pinocytosis, and active transfer. The total volume of CSF in the adult is about 140 ml. The volume of the ventricles is about 25 ml. CSF is absorbed across the arachnoid villi into the venous circulation. The rate of absorption correlates with the CSF pressure. Two major known causes are 

• Hyperbilirubinemia 
• Purulent CSF (Pseudomonas aeruginosa ventriculitis)

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References:

1. Seehusen DA, Reeves MM, Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003 Sep 15;68(6):1103-8. PMID: 14524396.

2. Escota G, Como J, Kessler H. The green cerebrospinal fluid. Am J Med. 2011 May;124(5):411-3. doi: 10.1016/j.amjmed.2011.01.002.