Reactive Pleocytosis After Repeated Lumbar Puncture-Implications for Clinical Practice

Lumbar puncture (LP) is a routine clinical procedure and, in some cases, is repeatedly performed for diagnostic or therapeutic reasons. The impact of repeated LP on cerebrospinal fluid (CSF) findings is not clear.

To investigate whether repeated LP is associated with reactive pleocytosis and disruption of blood-CSF barrier function and to determine the role of interval between repeated LP.

Patients with non-inflammatory neurological disease (NIND) and at least two consecutive LP were included. Longitudinal changes in CSF white blood cell count (WBC), CSF total protein (TP), and CSF/serum albumin quotient (Q_alb) were assessed depending on the time interval between the LP.

A total of 73 patients with a median age of 35 years (25th-75th percentile: 25-45) and a female predominance of 75% had second LP after 6 (3-19) days. Twenty (27%) patients developed pleocytosis with an increase of WBC count to 8/μl (6-15) with a maximum of 30/μl. Patients with pleocytosis had the follow-up LP significantly earlier than patients without pleocytosis, 3.5 (3-7) versus 7 (3-28) days. The majority of patients (90%) with CSF pleocytosis had the second LP within 10 days. Further repeated LP in a subgroup of patients revealed similar findings. CSF TP and Q_alb slightly increased in patients with pleocytosis.

Mild "reactive" CSF pleocytosis occurred in approximately one-third of patients after repeated LP, mostly when performed within 10 days.