Hypoglycorrhachia

Background

• Low CSF glucose

Differential Diagnosis

• Infectious
  • Bacterial meningitis (24%)
  • Fungal meningitis (15%)
  • Viral meningitis (6%)
  • Neurosyphilis (4%)
  • Cerebral toxoplasmosis (3%)
  • Others: tuberculous meningitis, amoebic meningoencephalitis, CMV-associated polyradiculopathy or meningoencephalitis, syphilitic meningitis, neuroborreliosis, neurocysticercosis
• Non-infectious
  • Stroke or intracranial bleed (13%)
    • Subarachnoid hemorrhage
  • Malignancy (11%)
    • Carcinomatous meningitis
    • Leukemia or lymphoma
  • Neurosarcoidosis (4%)
  • Others: GLUT-1 deficiency syndrome, rheumatoid meningitis, Currarino syndrome, systemic lupus erythematosus, Behçet disease, dermoid cyst, granulomatous polyangiitis, malignant atrophic papulosis
• If HIV-infected patients are excluded, stroke/bleed increases to 24% and malignancy to 22%

Further Reading

• The Differential Diagnosis of Hypoglycorrhachia in Adult Patients. Am J Med Sci. 2014;348(3):186–190. doi: 10.1097/MAJ.0000000000000217