{
  "abstract": "Cerebrospinal fluid cytology remains a cornerstone of diagnostic evaluation in infectious, autoimmune, haemorrhagic, and neoplastic disorders of the central nervous system despite advances in neuroimaging, molecular diagnostics, and digital technologies. This narrative review summarises established principles of cerebrospinal fluid cytology, highlights methodological limitations and diagnostic pitfalls, and integrates emerging developments, including automated cell counting, artificial intelligence, and telecytology. Pre-analytical factors are critical determinants of diagnostic accuracy. Delayed sample processing promotes pH-dependent autolysis and substantial cell loss, whereas rapid cytocentrifugation preserves cellular morphology and facilitates reliable assessment. Automated cell counters are increasingly implemented in routine laboratories and offer advantages in settings with limited technical staffing. However, current systems show limited precision in samples with low and slightly elevated cell counts and limited morphological evaluation. Manual chamber counting, particularly in the normal and low-cell-count range, remains the gold standard for quantitative CSF cell assessment, whereas expert microscopic examination remains the reference standard for qualitative cytomorphological assessment. Although the sensitivity of neuroimaging continues to improve, cerebrospinal fluid cytology retains a unique diagnostic role in the detection of infectious and neoplastic conditions and in the evaluation of subarachnoid haemorrhage. Cytological detection of erythrophages, siderophages, and haematoidin crystals can reveal haemorrhage and provide clues to its temporal stage. Overall, cerebrospinal fluid cytology remains a valuable diagnostic tool when integrated with clinical, laboratory, microbiological, immunological, and imaging findings. Careful recognition of common pitfalls is essential. We recommend rapid cerebrospinal fluid processing, routine preparation of cytospin-based stained slides with expert microscopic review, and the implementation of automated or digital methods only within clearly validated workflows.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, Hannover Medical School, 30625, Hannover, Germany. nay.sandra@mh-hannover.de.",
    "Department of Neurology, Hannover Medical School, 30625, Hannover, Germany.",
    "Department of Neurology, University of Ulm, 89081, Ulm, Germany.",
    "Department of Neurology, Medical University Lausitz-Carl Thiem, 03048, Cottbus, Germany.",
    "Medical Laboratory Bremen, 28355, Bremen, Germany.",
    "Department of Neurology, University Hospital and University Münster, 48149, Münster, Germany.",
    "Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, 5020, Salzburg, Austria.",
    "Department of Dermatology and Allergology, Paracelsus Medical University, 5020, Salzburg, Austria.",
    "Division of Neuroimmunology, Department of Neurology, Heidelberg University Hospital, 69120, Heidelberg, Germany.",
    "Department of Neurology, Friedrich-Alexander-University and University Hospital Erlangen-Nürnberg, 91054, Erlangen, Germany.",
    "Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.",
    "Department of Biochemical Diagnostics, University Hospital of Białystok, 15-269, Białystok, Poland.",
    "Department of Neurology, Medical University of Graz, 8036, Graz, Austria.",
    "Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany.",
    "Department of Neurology, Martin-Luther-University Halle-Wittenberg, 06120, Halle (Saale), Germany.",
    "Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, 26129, Oldenburg, Germany.",
    "Infectious Disease Serology and Immunology, Medica Medizinische Laboratorien Dr. F. Kaeppeli AG, 8032, Zurich, Switzerland.",
    "SYNLAB Holding Deutschland GmbH, 86156, Augsburg, Germany.",
    "Department of Neurology, Klinikum Braunschweig, 38126, Brunswick, Germany.",
    "Department of Neurology, Sozialstiftung Bamberg, 96049, Bamberg, Germany.",
    "Department of Neurology, University Medicine Greifswald, Greifswald, Germany.",
    "Department of Psychiatry, Max Planck Institute of Psychiatry, 80804, Munich, Germany.",
    "Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, 81377, Munich, Germany.",
    "Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075, Göttingen, Germany.",
    "Labopart Medical Laboratories, 01127, Dresden, Germany.",
    "Department of Neurology, GFO Kliniken Niederrhein, St. Josef Krankenhaus Moers, 47441, Moers, Germany. stefan.isenmann@st-josef-moers.de."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 32,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sandra Nay",
      "orcid": "0000-0002-4986-1181"
    },
    {
      "affs": [
        1
      ],
      "name": "Franz Felix Konen"
    },
    {
      "affs": [
        2
      ],
      "name": "Franziska Bachhuber"
    },
    {
      "affs": [
        3
      ],
      "name": "Alexander Dressel",
      "orcid": "0000-0002-9055-4327"
    },
    {
      "affs": [
        2
      ],
      "name": "Deborah Erhart"
    },
    {
      "affs": [
        4
      ],
      "name": "Andreas Gerritzen"
    },
    {
      "affs": [
        5
      ],
      "name": "Catharina C Gross"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Andrea Harrer"
    },
    {
      "affs": [
        8
      ],
      "name": "Andrea Hinger"
    },
    {
      "affs": [
        9,
        10,
        11
      ],
      "name": "Piotr Lewczuk"
    },
    {
      "affs": [
        2
      ],
      "name": "Jan Lewerenz"
    },
    {
      "affs": [
        12
      ],
      "name": "Michael Khalil"
    },
    {
      "affs": [
        8
      ],
      "name": "Mirjam Korporal-Kuhnke"
    },
    {
      "affs": [
        13
      ],
      "name": "Frank Leypoldt"
    },
    {
      "affs": [
        5
      ],
      "name": "Thiemo M Möllenkamp"
    },
    {
      "affs": [
        14
      ],
      "name": "Markus Otto"
    },
    {
      "affs": [
        15
      ],
      "name": "Astrid Petersmann"
    },
    {
      "affs": [
        16
      ],
      "name": "Axel Regeniter"
    },
    {
      "affs": [
        17
      ],
      "name": "Martin Roskos"
    },
    {
      "affs": [
        8
      ],
      "name": "Klemens Ruprecht"
    },
    {
      "affs": [
        18
      ],
      "name": "Annette Spreer"
    },
    {
      "affs": [
        19
      ],
      "name": "Herwig Strik"
    },
    {
      "affs": [
        20
      ],
      "name": "Marie Süße"
    },
    {
      "affs": [
        2
      ],
      "name": "Hayrettin Tumani"
    },
    {
      "affs": [
        21
      ],
      "name": "Manfred Uhr"
    },
    {
      "affs": [
        22
      ],
      "name": "Manfred Wick"
    },
    {
      "affs": [
        8
      ],
      "name": "Brigitte Wildemann"
    },
    {
      "affs": [
        23
      ],
      "name": "Jens Wiltfang"
    },
    {
      "affs": [
        24
      ],
      "name": "Thomas Zimmermann"
    },
    {
      "affs": [
        1
      ],
      "name": "Thomas Skripuletz",
      "orcid": "0000-0001-8550-335X"
    },
    {
      "affs": [
        25
      ],
      "name": "Stefan Isenmann"
    },
    {
      "name": "German Society for Cerebrospinal Fluid Diagnostics, Clinical Neurochemistry (DGLN e.V.)"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/30e3p3ykfgrga.bib",
  "cited_by": 0,
  "doi": "10.1007/s00401-026-03101-7",
  "fulltext_url": "https://europepmc.org/articles/PMC13722749",
  "id": "30e3p3ykfgrga",
  "issns": [
    "0001-6322",
    "1432-0533"
  ],
  "landing_url": "https://europepmc.org/article/MED/42961673",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2737|Clinical Laboratory Practices and Quality Control"
    ]
  ],
  "openalex": "W7224924291",
  "pdf_url": "https://europepmc.org/articles/PMC13722749?pdf=render",
  "pmcid": "PMC13722749",
  "pmid": "42961673",
  "published": "2026-10-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/30e3p3ykfgrga.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T03:21:21Z",
      "native_id": "MED:42961673",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42961673"
    },
    {
      "first_seen": "2026-11-04T12:21:31Z",
      "native_id": "PMC13722749",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s00401-026-03101-7"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Clinical Laboratory Practices and Quality Control",
      "subfield": "physiology"
    }
  ],
  "title": "CSF cytology: core principles, diagnostic pitfalls and emerging digital tools including artificial intelligence and telecytology.",
  "title_text": "CSF cytology: core principles, diagnostic pitfalls and emerging digital tools including artificial intelligence and telecytology.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-04T12:21:31Z",
  "url": "https://research.draconitic.com/paper/30e3p3ykfgrga",
  "venue": "Acta neuropathologica",
  "versions": []
}