AUBF Flashcards
CSF is first recognized by ____ in ______
Catugno, 1764
Functions of CSF
Supply nutrient to nervous tissue
Remove metabolic waste
Cushion the brain & spinal cord against trauma
Normal adult volume of CSF
140-170
Normal volume of CSF neonates
10-60
Reduce the amount of CSF in the brain by draining it to the abdomen or directly into the chambers of the heart
Ventricular Shunt
helps reduce the pressure on the brain
Shunting of CSF
Hollow plastic tube that is placed in the ventricle of the brain
Shunt
Ventricular peritoneal shunt located from the
brain to abdomen
Ventricular atrial shunt is located from brain to _____
heart
Lines the brain and the spinal cord
Protective layer
Meninges
directly in contact with skull bones
outermost
dura mater
Web-like structure - middle layer of meninges
Arachnoid
space where CSF flows
Subarachnoid space
directly in contact with brain
Innermost
Pia Mater
Capillary networks that form the CSF
Choroid Plexus
light-fitting endothelial cells: separates blood tissues and brain tissue
Blood Brain Barrier
functional barrier; separates blood tissues and cerebrospinal fluid
Blood CSF Barrier
Normal volume production of CSF
20/mL per hour
Cells that help production of CSF
Ependymal cells
Specimen collection for CSF procedure:
Lumbar tap/Lumbar puncture between 3rd and 4th or 4th and 5th lumbar vertebrae
Opening pressure is measured _____ in aspiration of CSF
First
CSF collection tubes order of draw:
Tube 1: Chemistry or serology
Tube 2: Microbio
Tube 3: Hematology
*Tube 4 if possible: micro
Storage for CSF tube 1
Frozen (0 to frozen)
Storage for CSF tube 3
Refrigerated
Increase in blood CSF may indicate
traumatic tap
Storage for CSF tube 2
Room temperature (20 to 24 deg C)
Appearance of CSF: Cloudy, Milky, Turbid
Protein, Lipid, WBC
Appearance of CSF: Normal
Crystal Clear
Appearance of CSF: Bloody
Intracranial hemorrhage, Traumatic tap
Appearance of CSF: Xanthochromic
Hemoglobin, Bilirubin, Carotene, ↑Protein, Melanin
Appearance of CSF: Pink
Oxyhemoglobin
Appearance of CSF: Yellow
High bilirubin content
Appearance of CSF: Orange
combination of oxyhemoglobin and bilirubin
Appearance of CSF: Clotted
Clotting factors introduced by traumatic tap
Appearance of CSF: Pellicle
Tubercular meningitis, seen after overnight of refrigeration
Appearance of CSF: Oily
Radiographic Contrast Media
Traumatic tap indication:
Uneven blood distribution
Clot formation
Supernatant: Not Xanthochromic
Intracranial Hemorrhage indication:
Even distribution of blood
No clot formation
Supernatant: Xanthochromic
Additional: Erythrophagocytosis: microscopically- macrophages with ingested RBCs
(+): D-Dimer
Cell count that is routinely performed on CSF
Leukocyte/wbc count
When is Leukocyte/WBC count performed on CSF
Traumatic tap
_______ are usually determined only when a traumatic tap has occurred and a correction for leukocytes or protein is desired
RBC counts
RBC disintegrates within
1 hour
CSF: ↓ by 40% in WBC disintegrates after
2 hours
increase in the number of cells in CSF
Pleocytosis
Normal values of WBC in ADULT CSF
0-5 cells/uL
Predominant cells in ADULT CSF
lympthocytes
Predominant cells in neotates CSF
monocytes
Normal values of WBC in neonates
0-30 cells/uL
Manual method for counting cells in CSF
Neubauer Counting Chamber
Counting calls of CSF
4 larger corner squares and large center squares
Area of large square neubauer chamber:
1 mm^2
Total Cell Count:
Cell counted x Dilution / Area x Depth
Needed for the correction of WBC Count & CSF Protein Results
RBC Count
Diluent for CSF RBC count
NSS
Diluent for WBC count CSF:
3% Glacial Acetic Acid
Can be added to diluting fluid of WBC count
Methylene Blue
Correction for Contamination of CSF
WBC added = WBC Blood x RBC CSF
RBC Blood
Subtract 1 WBC for every ____ RBCs present in the CSF
700
CSF Electrophoresis primary purpose:
detection of OLIGOCLONAL bands
Can determine if a fluid is indeed CSF
CSF Electrophoresis
Most Common Method of CSF electrophoresis
Agarose Gel Electrophoresis
Indicates immunoglobulin production
Oligoclonal Bands
Oligoclonal bands are located in the ____ region of the protein electrophoresis
GAMMA
Oligoclonal bands in CSF only
Multiple Sclerosis; Neurologic Disorder, Encephalitis, Neurosyphilis, Guillain Barre Syndrome
Oligoclonal Bands in CSF and Serum
HIV infection
Oligoclonal bands in Serum only; CSF banding because of BBB leakage or blood contamination during lumbar tap.
Leukemia, Lymphoma, Viral Infections
Indicates recent destruction of the myelin sheath that protects the axon of the neurons
Myelin Basic Protein
Myelin Basic Protein can be used to monitor ________-
Multiple sclerosis
Myelin Basic Protein theorized that the inflammatory response in multiple sclerosis is triggered by ________
molecular mimicry
Normal volume of CSF Glucose:
60-70% of plasma glucose
Blood glucose should be drawn ________ prior to lumbar tap (CSF)
2 hours
Can be used to determine the cause of meningitis
CSF glucose
Increased levels of CSF glucose is always a result of
plasma elevations
Decreased levels of CSF glucose
caused by alteration in transport in BBB ↑ used by braincells
Destruction of tissue within the CNS due to hypoxia causes the production of
Increased CSF lactate
Aid in the diagnosis and management of meningitis cases
CSF Lactate
Elevation of CSF lactate is consistent with:
Bacterial, Tubercular, and Fungal Meningitis
Level of CSF lactate when treatment is successful
declines rapidly
Used to monitor severe head injuries
CSF Lactate
Falsely elevated CSF lactate is due to
xanthochromic or hemolyzed samples
Preferred over direct measurement of CSF ammonia
CSF Glutamine
CSF Glutamine normal values
8-18 mg/dL
Elevated levels of CSF glutamine is associated with
liver disorder that result in blood and CSF ammonia
CSF glutamine is produced from ____ and ____ by the brain cell
Ammonia & α-ketoglutarate
______ is an indirect test for the presence of excess ammonia in CSF
Glutamine
Frequently requested procedure for patients with coma of unknown origin
CSF Glutamine
CSF glutamine is ↑ in approximately 75% of children with
Reye Syndrome
Bacterial meningitis is recovered after ____
24 hours
Tubercular meningitis is recovered after ___
6 weeks