The significance of elevated CSF lactate

Chow, Signy

doi:10.1136/adc.2005.075317

Cited by 54 publications

(35 citation statements)

References 5 publications

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“…CSF lactate concentrations can be raised in association with seizures, bactarial, fungal of tuberculous meningitis or encephalitis, cerebral ischemia, neurosarcoidosis, malignancy and metabolic disorders [27]. In most of these disorders, however, other CSF parameters such as leucocyte count and protein count are raised as well.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

et al. 2012

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Cerebrospinal fluid (CSF) analysis is an important tool in the diagnostic work-up of many neurological disorders, but reference ranges for CSF glucose, CSF/plasma glucose ratio and CSF lactate based on studies with large numbers of CSF samples are not available. Our aim was to define age-specific reference values. In 1993 The Nijmegen Observational CSF Study was started. Results of all CSF samples that were analyzed between 1993 and 2008 at our laboratory were systematically collected and stored in our computerized database. After exclusion of CSF samples with an unknown or elevated erythrocyte count, an elevated leucocyte count, elevated concentrations of bilirubin, free hemoglobin, or total protein 9,036 CSF samples were further studied for CSF glucose (n = 8,871), CSF/plasma glucose ratio (n = 4,516) and CSF lactate values (n = 7,614). CSF glucose, CSF/plasma glucose ratio and CSF lactate were age-, but not sex dependent. Age-specific reference ranges were defined as 5–95th percentile ranges. CSF glucose 5th percentile values ranged from 1.8 to 2.9 mmol/L and 95th percentile values from 3.8 to 5.6 mmol/L. CSF/plasma glucose ratio 5th percentile values ranged from 0.41 to 0.53 and 95th percentile values from 0.82 to 1.19. CSF lactate 5th percentile values ranged from 0.88 to 1.41 mmol/L and 95th percentile values from 2.00 to 2.71 mmol/L. Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age. These reference values allow a reliable interpretation of CSF results in everyday clinical practice. Furthermore, hypoglycemia was associated with an increased CSF/plasma glucose ratio, whereas hyperglycemia did not affect the CSF/plasma glucose ratio.

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Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

et al. 2012

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“…Conversely, elevations of plasma lactate and/or pyruvate levels may be seen in a range of conditions other than primary mitochondrial disease, including spurious elevation due to poor collection or handling techniques, physiological elevation as a result of secondary mitochondrial dysfunction which may occur in a wide range of systemic diseases and metabolic disorders, as well as nutritional deficiency of thiamine [11]. It is well known that CSF lactate can be increased in CNS infection, stroke, malignancy, inflammation, and seizures, which limits the value of this laboratory finding in the absence of other objective confirmatory findings [12].…”

Section: Minimally-invasive Biochemical Analyte Interpretation Lactatmentioning

confidence: 94%

The in-depth evaluation of suspected mitochondrial disease

Haas

Parikh

Falk

et al. 2008

Molecular Genetics and Metabolism

318

300

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Mitochondrial disease confirmation and establishment of a specific molecular diagnosis requires extensive clinical and laboratory evaluation. Dual genome origins of mitochondrial disease, multiorgan system manifestations, and an ever increasing spectrum of recognized phenotypes represent the main diagnostic challenges. To overcome these obstacles, compiling information from a variety of diagnostic laboratory modalities can often provide sufficient evidence to establish an etiology. These include blood and tissue histochemical and analyte measurements, neuroimaging, provocative testing, enzymatic assays of tissue samples and cultured cells, as well as DNA analysis. As interpretation of results from these multifaceted investigations can become quite complex, the Diagnostic Committee of the Mitochondrial Medicine Society developed this review to provide an overview of currently available and emerging methodologies for the diagnosis of primary mitochondrial disease, primarily focusing on disorders characterized by impairment of oxidative phosphorylation. The aim of this work is to facilitate the diagnosis of mitochondrial disease by geneticists, neurologists, and other metabolic specialists who face the challenge of evaluating patients of all ages with suspected mitochondrial disease.

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“…14 Collection artifacts are less of a problem, although a variety of brain disorders, status epilepticus in particular, can transiently increase CSF lactate. 15 Surprisingly, urine lactate correlates less well with the presence of mitochondrial disease. 16 …”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and management of mitochondrial disease: a consensus statement from the Mitochondrial Medicine Society

Parikh

Goldstein

Koenig³

et al. 2015

Genetics in Medicine

464

426

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Purpose The purpose of this statement is to review the literature regarding mitochondrial disease and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are engaged in diagnosing and treating these patients. Methods The Writing Group members were appointed by the Mitochondrial Medicine Society. The panel included members with expertise in several different areas. The panel members utilized a comprehensive review of the literature, surveys, and the Delphi method to reach consensus. We anticipate that this statement will need to be updated as the field continues to evolve. Results Consensus-based recommendations are provided for the diagnosis and treatment of mitochondrial disease. Conclusion The Delphi process enabled the formation of consensus-based recommendations. We hope that these recommendations will help standardize the evaluation, diagnosis, and care of patients with suspected or demonstrated mitochondrial disease.

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The significance of elevated CSF lactate

Cited by 54 publications

References 5 publications

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

The in-depth evaluation of suspected mitochondrial disease

Diagnosis and management of mitochondrial disease: a consensus statement from the Mitochondrial Medicine Society

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