CSF VDRL test

CSF VDRL test

Definition:

The CSF-VDRL test is used to diagnose neurosyphilis (syphilis associated with brain or neurologic involvement). This test detects the presence of reaginic antibodies in cerebrospinal fluid (CSF), which is the fluid that surrounds the spinal cord and brain.

Alternative Names:

Venereal Disease Research Laboratory slide test - CSF

How the test is performed:

The test is performed on a cerebrospinal fluid (CSF) sample obtained by lumbar puncture (spinal tap).

How to prepare for the test:

The procedure to be done is a lumbar puncture (spinal tap). Before the procedure - you will be asked to sign a consent form after reviewing the risks of this test. After the lumbar puncture is done, you will be asked to remain lying down flat for 6 hours.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:

infant test or procedure preparation (birth to 1 year)
toddler test or procedure preparation (1 to 3 years)
preschooler test or procedure preparation (3 to 6 years)
schoolage test or procedure preparation (6 to 12 years)
adolescent test or procedure preparation (12 to 18 years)

How the test will feel:

You will be asked to lie on your side in the fetal position with your legs curled towards your chest. The area where the needle will be inserted (in your lower back) will be thoroughly cleaned. The scrub will feel cold and wet. You will then receive an injection at the site with local anesthesia which may sting or burn when first injected. There will be a hard pressure sensation when the needle is inserted, and there is usually some brief pain as the needle goes through. This pain should stop in a few seconds. Overall, discomfort is mild to moderate. The entire procedure usually takes about 30 minutes but may take longer. The actual fluid collection only takes a few minutes.

Why the test is performed:

The CSF-VDRL test is used to test for syphilis in the brain and/or spinal cord. As this usually reflects late (tertiary) syphilis, the blood screening tests such as VDRL or RPR may be falsely negative.

Normal Values:

As this test has a high rate of false negatives, a negative test does not rule out neurosyphilis. Other markers of inflammation such as elevated protein levels or excess numbers of white blood cells may be suggestive of neurosyphilis even when the CSF-VDRL is negative.

What abnormal results mean:

A reactive VDRL test when using a CSF sample indicates neurosyphilis.

What the risks are:

Risks of lumbar puncture include:
- hypersensitivity (allergic) reaction to the anesthetic
- discomfort during the test
- headache after the test
- bleeding into the spinal canal
brain herniation (if performed on a person with increased intracranial pressure) which may result in brain damage and/or death
damage to the spinal cord/nerve roots

Special considerations:

Since the CSF VDRL test can have false negative results, additional tests such as protein levels and white blood cell counts may be done on the spinal fluid to diagnose neurosyphilis.

Review Date: 11/16/2001
Reviewed By: Rocio Hurtado, M.D., Infectious Diseases Division, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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