'Normal' CSF in bacterial meningitis

JAMA. 1980 Sep 26;244(13):1469-71.


Cerebrospinal fluid with a normal cell count, glucose and protein values, and a negative Gram's stain smear is usually assumed to exclude the possibility of meningitis. We describe four patients and review from literature 19 patients with pyogenic meningitis in whom the CSF initially appeared normal. Thus, finding minimal or no initial CSF abnormality is consistent with early or developing bacterial meningitis. Repeated lumbar puncture and CSF examination within 24 hours should be considered in all febrile patients in whom the clinical features remain compatible with meningitis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Cerebrospinal Fluid / cytology
  • Cerebrospinal Fluid / microbiology
  • Cerebrospinal Fluid Proteins / analysis
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Meningitis, Meningococcal / cerebrospinal fluid*
  • Meningitis, Meningococcal / diagnosis
  • Neisseria meningitidis / isolation & purification
  • Proteus mirabilis / isolation & purification
  • Reference Values
  • Suppuration


  • Cerebrospinal Fluid Proteins