15: CSF Analysis

Question 1

What makes up the BBB?

Answer 1

Choroid plexus

Question 2

What makes up the blood-CSF barrier?

Answer 2

Arachnoid

Question 3

What makes up the CSF-brain barrier?

Answer 3

Ependyma and pia

Question 4

Why is CSF low cellularity?

Answer 4

Plasma ultrafiltrate and membrane secretion

Question 5

Why should you not collect CSF if increased intracranial pressure?

Answer 5

Causes brain herniation

Question 6

What do you use for cell count and cytology?

Answer 6

EDTA

Question 7

What do you use for protein albumin and serology?

Answer 7

Protein albumin and serology

Question 8

What time after collection is CSF analysis best?

Answer 8

Within 30 mins

Question 9

If keeping longer than 30 mins, what do you need to add to CSF?

Answer 9

Serum/albumin or cells were burst

Question 10

Why do you need hemocytomer for CSF analysis?

Answer 10

Cell numbers too low for automated count

Question 11

What stain do you use for CSF?

Answer 11

None

Question 12

How do you concentrate cells from CSF?

Answer 12

Centrifuge, membrane filter selection, gravity sedimentation, then air dry and count

Question 13

How do you measure CSF protein?

Answer 13

Urine dipstick

Question 14

What does high CSF protein suggest?

Answer 14

Inflammation or tumour

Question 15

WHat does an Ig index do?

Answer 15

Compares CSF to serum Ig numbers

Question 16

What else do you measure in CSF?

Answer 16

Albumin, Igs, virus specific Ag, PCR

Question 17

How much RBC and WBC should there be in CSF?

Answer 17

No RBC, very little WBC

Question 18

How can RBCs enter the CSF?

Answer 18

Contamination, haemorrhage, iatrogenic

Question 19

How can WBCs enter the CSF?

Answer 19

Inflammation or blood contamination

Question 20

How do you correct for blood contamination in CSF?

Answer 20

Remove 1 WBC for every 500 RBC

Question 21

What will be present in the CSF if haemorrhage is fresh?

Answer 21

Platelets

Question 22

Which contrast agents do you use for CAT and MRI scans?

Answer 22

Iodine

Question 23

Why do you take cell count before injecting contrast agents?

Answer 23

Affects cells counts - neutrophils and macrophages will increase within 24 hours

Question 24

How long can cell changes last after contrast contrast agent use?

Answer 24

5-10 days

Question 25

Which cells are in normal CSF?

Answer 25

Mononuclear cells, choroid/ependymal cells, rare neutrophils and eosinophils

Question 26

What kind of macrophages are abnormal in CSF?

Answer 26

Foamy/reactive

Question 27

What colour can CSF be in bacterial meningitis?

Answer 27

Clear to turbid

Question 28

What parameters are increased in bacterial meningitis?

Answer 28

Cells, proteins, IgG index

Question 29

What % neutrophils do you see in bacterial meningitis?

Answer 29

over 75% degenerate

Question 30

What kind of animals especially get bacterial meningitis?

Answer 30

Young

Question 31

Which cells/parameters do you see increased in fungal meningitis?

Answer 31

Mixed cell pleocytosis, increased protein, sometimes eosinophils

Question 32

How common is fungal meningitis?

Answer 32

Rare

Question 33

What is correlation between CSF and blood eosinophils?

Answer 33

None

Question 34

What does eosinophils in CSF indicate?

Answer 34

The meningitis is fungal or immune mediated

Question 35

What are two forms of parasitic meningitis?

Answer 35

Common protozoal myelitis or verminous encephalomyelitis

Question 36

What species gets verminous encephalomyelitis?

Answer 36

Horse

Question 37

Which other parasites can cause meningitis?

Answer 37

Neospora or toxoplasma

Question 38

Which cell changes do you see in parasitic meningitis?

Answer 38

Mixed pleocytosis

Question 39

Which kind of meningoencephalomyelitis does parasitic meningitis cause?

Answer 39

Multifocal granulomatous

Question 40

What kind of inflammation do you see in viral disease?

Answer 40

Non-suppurative

Question 41

What cell/parameter changes do you see in viral disease?

Answer 41

Increased cell numbers, protein and IgG index, xanthochromia, mononuclear pleocytosis

Question 42

What cell/parameter changes does herpes give?

Answer 42

Increased IgG and IgA, increased pleocytotic lymphocytes

Question 43

What can CSF be like in rabies?

Answer 43

Normal

Question 44

Should you collect CSF if rabies is suspected?

Answer 44

No

Question 45

What colour is CSF in immune-mediated disease?

Answer 45

Clear to hazy

Question 46

What is a symptom of immune-mediated disease?

Answer 46

headache

Question 47

In which species is immune-mediated disease common?

Answer 47

Dogs

Question 48

Which cell/parameter changes do you see in immune-mediated disease?

Answer 48

Increased cells and proteins, pleocytosis of any cell types

Question 49

What may you see in CSF following intervertebral disc disease?

Answer 49

Cartilaginous emboli

Question 50

What can CSF be like in intervertebral disc disease?

Answer 50

Normal

Question 51

What are two different CSF changes you may see in IVDD?

Answer 51

Mild mononuclear pleocytosis, foamy macrophages, increased protein OR pleocytosis, normal protein, albumin and IgG

Question 52

What can CSF be like in neoplasia?

Answer 52

Normal, but commonly there is increased protein and albumin and pleocytosis with abnormal cells

Question 53

What is the usual neoplasia causing CSF changes?

Answer 53

Lymphoma, or meningioma or choroid plexus tumour