10.2 more cards Flashcards
List the 2 urgent indications for an LP
Suspected CNS infection (meningoencephalitis)
Suspected SAH in pt with negative head CT
LP should not be done with increased ICP & space occupying lesions with risk for what?
LP may cause brain herniation through foramen magnum due to acute downward pressure gradient
Infection, bleeding, and headaches are 3 potential complications of what?
LP
A persistent CSF leak can cause what Sx?
Headaches
obstruction of jugular veins or superior vena cava can do what?
Increase ICP
What does the breakdown of hemoglobin cause in CSF?
Xanthochromia
Does normal CSF have cells?
No; normal CSF is acellular (no cells), but may have a small number of certain cells when sampled by LP
WBC elevations (pleocytosis) can occur in what 3 conditions?
1) Infection
2) Traumatic tap
3) Noninfectious inflammatory states
Acute infectious meningitis: Neutrophils (PMNs) usually predominate in ___________; lymphocytes usually predominate in ___________.
bacterial; viral
Molecular tests can detect what?
Viruses, bacteria, and fungi
[molecular tests use a variety of methods, including NAAT, serology (antibodies), antigen detection]
Infectious and noninfectious conditions, those associated with obstruction of CSF flow, and bleeding can all cause what?
Increased CSF total protein
Albumin-to-globulin ratio normally higher in CSF than blood. Why?
Albumin molecule is smaller than globulins
Should CSF have a lot of immunoglobulins, or a few?
Very few
[CSF inflammatory disorders]
How do you ID increased immunoglobulins in CSF?
1) Increased IgG index
2) Spikes/bands on CSF protein electrophoresis + immunofixation
[of increased immunoglobulin production]
What 2 types of immunoglobulin bands are on CSF protein electrophoresis + immunofixation can be found when immunoglobulins are increased?
1) Oligoclonal: neuroinflammatory disorders such as Multiple sclerosis (MS)
2) Monoclonal: B cell/plasma cell disorder (e.g., malignancy)
When might CSF glucose be low?
Bacterial/fungal CNS infections
1) When might CSF glucose be normal?
2) When might it be high?
1) Viral CNS infections
2) Hyperglycemia
Is CSF glucose normally lower or higher than in serum?
Lower
Elevated CSF levels of lactic acid may occur in what 3 situations?
1) Hypoxic-ischemic cerebral injury
2) SAH
3) Infectious meningitis
Lactic acid is often elevated in _____ ____________meningitis (prior to abx) but normal in ______ meningitis
acute bacterial; viral
What CSF analysis may help identify malignancy/metastasis?
Cytology and Tumor markers
In what type of meningitis will CSF WBC count be very high?
Bacterial
When may opening pressure be high? (2)
Subarachnoid hemorrhage (SAH)
Acute Bacterial Meningitis
Is there xanthochromia with traumatic LP?
No
