title: The differential diagnosis of hypoglycorrhachia in adult patients.
abstract: OBJECTIVE
  Hypoglycorrhachia, a low glucose level in the cerebrospinal fluid (CSF), can suggest bacterial, fungal or tuberculous meningitis. When tests for these common infectious etiologies are negative, many clinicians are unsure of which diagnoses to consider, resulting in delayed treatment. The authors analyzed the diagnoses associated with hypoglycorrhachia to determine their relative frequencies at our institution and summarized all the diagnoses associated with hypoglycorrhachia in the literature.
  
  
  METHODS
  Retrospective analysis of adults with hypoglycorrhachia at a tertiary care teaching hospital over a 5-year period. Inclusion criteria included CSF glucose <40 mg/dL and age 18 years or older. Exclusion criteria included CSF/serum glucose ≥0.6.
  
  
  RESULTS
  Eighty-nine unique hypoglycorrhachia episodes were identified. The most common etiologies among all episodes of hypoglycorrhachia were bacterial meningitis (24%), fungal meningitis (15%), stroke/bleed (13%), malignancy (11%), viral meningitis (6%), neurosarcoidosis (4%), neurosyphilis (4%) and cerebral toxoplasmosis (3%). The most common etiology was fungal meningitis (38%) among HIV-infected patients and bacterial meningitis (62%) among neurosurgery patients. However, in patients without HIV or neurosurgical history, noninfectious etiologies (stroke/bleed, 24%; malignancy, 22%) were most common.
  
  
  CONCLUSIONS
  Many diagnoses, both infectious and noninfectious, lead to hypoglycorrhachia and must be considered in the differential diagnosis.
authors: Department of Internal Medicine, Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk, Virgina.
authors: Eric
authors: E
authors: Chow
authors: Stephanie B
authors: SB
authors: Troy
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D016921:Meningitis, Fungal / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D005947:Glucose