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Note: This table is incomplete (e.g., I have not reviewed the literature on hypoglycorrhachia in fungal meningitis and did not review all the literuture on other etiologies). Therefore, there are many boxes with "?". Also, the categorization of things as "Possible", "Likely", etc. is based on my read of some of this literature. I'd love to hear your feedback. Please send me a DM on Twitter (@tony_breu) with your thoughts.
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CauseBreakdown of causes (1,2)Bacterial consumption?Leukocyte consumption?Brain tissue consumption?Decreased transport into CSF?Other?
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Bacterial meningitis23-24%Possible, though conflicting data (5,6,15)Likely (7-9). Also synergy with bacteria. (10)Possible (14)Possible (12-14)?
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Fungal meningitis15-23%NoPossible, though lymphocytes consume less glucose than neutrophils (9)???
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Stroke/bleed13%NoNo??Release of glycolytic enzymes from RBCs? (17)
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Malignancy11%NoPossible, though lymphocytes and monocytes consume less glucose than neutrophils (9)?Possible (15)Consumtion by malignant cells? (11)
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Viral meningitis6%-13%NoPossible, though lymphocytes consume less glucose than neutrophils (9)???
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Neurosarcoidosis4%NoPossible, though lymphocytes consume less glucose than neutrophils (9)?Possible (16)?
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Neurosyphilis4%?????
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Toxoplasmosis3%No????
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Tuberculosis3%PossiblePossible, though lymphocytes consume less glucose than neutrophils (9)?Likely (3,4)?
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Other3-8%No????
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Indeterminate/
Unknown		11-35%N/AN/A?N/A?
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1. Chow E, Troy SB. The Differential Diagnosis of Hypoglycorrhachia in Adult Patients. The American Journal of the Medical Sciences. 2014;348(3):186-190.
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2. Shrikanth V, Salazar L, Khoury N, Wootton S, Hasbun R. Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance. International Journal of Infectious Diseases. 2015;39:39-43.
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3. Weichsel M, Herzger G. Significance of the diminution of the spinal fluid sugar in tuberculous meningitis. The Journal of Pediatrics. 1936;9(6):763-770.
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4. SIFONTES JE;WILLIAMS RD;LINCOLN EM;CLEMONS H. Observations on the effect of induced hyperglycemia on the glucose content of the cerebrospinal fluid in patients with tuberculous meningitis. American review of tuberculosis. 2021;67(6).
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5. Goldring S, Harford CG. Effect of Leucocytes and Bacteria on Glucose Content of the Cerebrospinal Fluid in Meningitis. Experimental Biology and Medicine. 1950;75(3):669-672.
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6. Baud MO, Vitt JR, Robbins NM, et al. Pleocytosis is not fully responsible for low CSF glucose in meningitis. Neurology - Neuroimmunology Neuroinflammation. 2017;5(1):e425.
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7. Petersdorf RG, Garcia M, Swarner DR. Mechanism of Hypoglycorrhachia in Experimental Pneumococcal Meningitis. Experimental Biology and Medicine. 1959;102(3):669-672.
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8. Petersdorf RG, Swarner DR, Garcia M. Further Observations on Mechanism of Hypoglycorrhachia in Experimental Meningitis. Experimental Biology and Medicine. 1960;104(1):65-68.
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9. Bretz G, Mauer AM. Glucose consumption by polymorphonuclear leukocytes in the cerebrospinal fluid of patients with bacterial meningitis. The Journal of Pediatrics. 1967;70(5):767-771.
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10. PETERSDORF RG. The Fall in Cerebrospinal Fluid Sugar in Meningitis. Archives of Neurology. 1961;4(1):21.
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11. Levinsky WJ. Hypoglycorrhachia (Low Cerebrospinal-Fluid Sugar) in Diffuse Meningeal Neoplasm. New England Journal of Medicine. 1963;268(4):198-199.
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12. Cooper AJ;Beaty HN;Oppenheimer SI;Goodner CJ;Petersdorf RG. Studies on the pathogenesis of meningitis. VII. Glucose transport and spinal fluid production in experimental pneumococcal meningitis. The Journal of laboratory and clinical medicine. 2017;71(3).
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13. Prockop LD. Experimental Pneumococcal Meningitis. Archives of Neurology. 1968;19(5):449.
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14. Menkes JH. The causes for low spinal fluid sugar in bacterial meningitis: another look. Pediatrics. 2017;44(1).
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15. Hochwald GM, Nakamura S, Chase R, Gorelick J. Cerebrospinal fluid glucose and leukocyte responses in experimental meningitis. Journal of the Neurological Sciences. 1984;63(3):381-391.
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16. Sarva H, Chapman R, Omoregie E, Abrams C. The challenge of profound hypoglycorrhachia: two cases of sarcoidosis and review of the literature. Clinical Rheumatology. 2011;30(12):1631-1639.
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17. Varon J, Bailon T, Raney RBeverly. Another cause of hypoglycorrhachia. The Journal of Emergency Medicine. 1996;14(5):637-638.
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Link to PDFs of most of these papers
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