Pandy's test (or Pandy's reaction) is done on the CSF (cerebrospinal fluid) to detect the elevated levels of

protein Proteins are large biomolecules and macromolecules that comprise one or more long chains of amino acid residues. Proteins perform a vast array of functions within organisms, including catalysing metabolic reactions, DNA replication, respo ...

s (mainly

globulins The globulins are a family of globular proteins that have higher molecular weights than albumins and are insoluble in pure water but dissolve in dilute salt solutions. Some globulins are produced in the liver, while others are made by the immune ...

). This test is named after the Hungarian

neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...

, Pándy Kálmán (1868–1945) who developed this test in the year 1910.

Principle

Proteins (

globulin The globulins are a family of globular proteins that have higher molecular weights than albumins and are insoluble in pure water but dissolve in dilute salt solutions. Some globulins are produced in the liver, while others are made by the immune ...

and

albumin Albumin is a family of globular proteins, the most common of which are the serum albumins. All the proteins of the albumin family are water-soluble, moderately soluble in concentrated salt solutions, and experience heat denaturation. Albumins ...

) are precipitated by a saturated solution of phenol in water. The reagent used is

phenol Phenol (also called carbolic acid) is an aromatic organic compound with the molecular formula . It is a white crystalline solid that is volatile. The molecule consists of a phenyl group () bonded to a hydroxy group (). Mildly acidic, it req ...

(

carbolic acid Phenol (also called carbolic acid) is an aromaticity, aromatic organic compound with the molecular chemical formula, formula . It is a white crystalline solid that is volatility (chemistry), volatile. The molecule consists of a phenyl group () ...

crystals dissolved in water) or,

pyrogallic acid Pyrogallol is an organic compound with the formula C6H3(OH)3. It is a water-soluble, white solid although samples are typically brownish because of its sensitivity toward oxygen. It is one of three isomers of benzenetriols. Production and reac ...

or,

cresol Cresols (also hydroxytoluene or cresylic acid) are a group of aromatic organic compounds. They are widely-occurring phenols (sometimes called ''phenolics'') which may be either natural or manufactured. They are also categorized as methylphenol ...

, usually termed as Pandy's reagent or Pandy's solution.

Procedure

One drop of CSF sample (collected from the patient by

lumbar puncture Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to ...

technique), is added to about 1ml of Pandy's solution. The turbid appearance signifies the presence of elevated levels of globulin protein in the CSF and is regarded as positive Pandy's reaction. The CSF from a normal adult shows no turbidity or precipitates and this is a negative Pandy's reaction.

Reactions and Results

Proteins in the cerebrospinal fluid, normally albumin and globulin are present in the ratio of 8 to 1. Increases in protein levels are of diagnostic value in neurological diseases. ''The normal CSF is clear and transparent fluid. The Pandy's reaction makes it translucent or opaque.''

Positive test

A positive test shows a bluish-white streak of precipitated proteins. The degree of turbidity depends on the amount of protein in the CSF. It can vary from faint turbidity (mild to moderate elevation in CSF proteins) to dense milky precipitate (high protein content in CSF). The positive Pandy's reaction may indicate one or more of the following pathological conditions: *

Diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

Brain tumor A brain tumor occurs when abnormal cells form within the brain. There are two main types of tumors: malignant tumors and benign (non-cancerous) tumors. These can be further classified as primary tumors, which start within the brain, and seconda ...

(

Meningioma Meningioma, also known as meningeal tumor, is typically a slow-growing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. Symptoms depend on the location and occur as a result of the tumor pressing o ...

Acoustic neuroma A vestibular schwannoma (VS), also called acoustic neuroma, is a benign tumor that develops on the vestibulocochlear nerve that passes from the inner ear to the brain. The tumor originates when Schwann cells that form the insulating myelin sheath o ...

or,

Ependymoma An ependymoma is a tumor that arises from the ependyma, a tissue of the central nervous system. Usually, in pediatric cases the location is intracranial, while in adults it is spinal. The common location of intracranial ependymomas is the fourt ...

) * Encapsulated

brain abscess Brain abscess (or cerebral abscess) is an abscess caused by inflammation and collection of infected material, coming from local (ear infection, dental abscess, infection of paranasal sinuses, infection of the mastoid air cells of the temporal bone ...

Spinal cord tumor Spinal tumors are neoplasms located in either the vertebral column or the spinal cord. There are three main types of spinal tumors classified based on their location: extradural and intradural (intradural-intramedullary and intradural-extramedullar ...

Multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...

* Acute purulent

Meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...

* Granulomatous Meningitis * Carcinomatous Meningitis *

Syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...

(protein may be normal if longstanding) *

Guillain–Barré syndrome Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. Typically, both sides of the body are involved, and the initial symptoms are changes in sensation or pain often ...

nfectious_polyneuritis.html" ;"title="polyneuritis.html" ;"title="nfectious polyneuritis">nfectious polyneuritis">polyneuritis.html" ;"title="nfectious polyneuritis">nfectious polyneuritis(Protein rises after 5–7 days) * Cushing's disease * Connective tissue disease * Uremia * Myxedema * Cerebral hemorrhage

Negative test

No cloudy turbidity observed. The CSF sample is normal i.e. with normal protein contents. ''Please note that the normal CSF protein is also obtained in several pathological conditions like viral CNS infections,

brainstem glioma A brainstem glioma is a cancerous glioma tumor in the brainstem. Around 75% are diagnosed in children and young adults under the age of twenty, but have been known to affect older adults as well. Brainstem gliomas start in the brain or spinal ...

ischemic Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...

cerebrovascular Cerebrovascular disease includes a variety of Medicine, medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often Angiopathy, damaged or deformed in ...

accident.''

References

# Merriam-Webster's Free Medical Dictionary. http://www.merriam-webster.com/medical/pandy%27s+test?show=0&t=1288164619 # Biology-Online Dictionary. http://www.biology-online.org/dictionary/Pandys_reaction # Kooiker and Roberts (1998) Procedures in ER # Ravel (1995) Lab Medicine, Mosby # Tunkel and Mandell (2000) Infectious Disease # {{cite journal , pmid = 14524396 , volume=68 , title=Cerebrospinal fluid analysis , date=September 2003 , vauthors=Seehusen DA, Reeves MM, Fomin DA , journal=Am Fam Physician , pages=1103–8

External links

Diagnostic test A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests such as, physical and visual exams, diagnostic imaging, genetic ...

CSF tests