AUBF CEREBROSPINAL FLUID Flashcards by Sharmaine Madjid

a clear, colorless fluid which is chiefly dialysate from the blood (a plasma ultra- filtrate).

csf

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csf is similar to serum but..

differs in its concentration of the major constituents.

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csf differs from plasma as..

many of the crystalloids in the CSF are of different concentrations.

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high level csf crystalloids

sodium and chloride

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low level csf crystalloids

potassium, bicarbonate, phosphate, sulphate and glucose

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MAJOR CONSTITUENTS OF CSF

protein, glucose and chloride

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major constituent of csf that is extremely low w/ no fibrinogen

protein

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major constituent of csf that is approximately 2/3 of that blood sugar.

glucose

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major constituent of csf that is about 25% higher than plasma chloride.

chloride

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csf is formed in the..

highly vascular choroid plexuses

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the tufts of capillary blood vessel in the ventricles of the brain.

vascular choroid plexuses

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csf is formed by

filtration (secretion and diffusion) from the blood plasma.

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location of csf

internal and external

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internally…

fills the ventricles of the brain (ventricular fluid), the cisternae, cisternal fluid and the canal of the spinal cord.

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externally…

fills the space between the pia and arachnoid membranes surrounding the brain and spinal cord (spinal fluid).

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functions of csf

buffer or cushion
medium of exchange
equalizes pressure
excretory channel

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collection of csf is..

collected by making a spinal puncture.

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occurs if the needle inadvertently has entered an epidural vein during insertion or simply, may blood upon collection

traumatic tap

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types of puncture

lumbar puncture
cisternal puncture
ventricular puncture

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relatively safe and simple procedure/puncture

lumbar

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puncture in lumbar is..

between the 3rd and 4th
vertebrae of the lumbar region.

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diagnosis of lumbar puncture

obtain spinal fluid for study.
estimate intracranial pressure.
test for spinal block.
introduce air or a lipoidal substance.

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therapeutic in lumbar puncyure

introduce serum, penicillin, streptomycin, or anesthetic substance.
remove blood or irritative exudates.

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CONTRAINDICATIONS OF LUMBAR PUNCTURE

A. Subtentorial Tumors
B. Presence of generally increased intracranial pressure

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more dangerous than a lumbar puncture

CISTERNAL PUNCTURE (cistera magna or suboccipital)

cisternal puncture is done under ff. conditions:

blocked spinal canal deformity of the vertebrae infections of the tissue of the back.

a csf puncture done for last resort.

ventricular puncture

ventricular puncture is done frequently on infants

frequently done in infants whose fontanelles are still open.

ventricular puncture is rarely done in adults

rarely done in adults except in connection with ventriculography.

amount of csf in cc per pound of body weight

1 cc

amount of csf in cc in everyday production

100-150 cc

increased amount in acute and chronic congestion of the meninges is due to..

due to increased transudation of plasma and to increase permeability of the choroid plexus

increased amount in acute and chronic infections is due to..

due to production of inflammatory exudate and to increase permeability of capillaries

csf pressure (position)

horizontal position

csf pressure (water)

between 70 and 200 mm of water

csf pressure (mercury)

0-8 mm. of mercury

csf pressure (average)

average of 100-150 mm.

normal color of csf

clear and colorless as distilled water

fresh red colored csf is due to

due to fresh blood (punctured while inserting needle)

dull red or brown is due to

(depends on lesion’s age) may be due to hemorrhage.

yellow colored csf is due to

due to blood pigments from disintegration of RBC within the subarachnoid space

another word for yellow color

xanthochromic

greenish or grayish colored csf is due to

due to pus cells in severe inflammatory reactions and in acute meningitis.

normal transparency of csf

clear

cloudy transparency of csf is due to

due to fewer than 200 white cells/cu.mm

hazy transparency of csf is due to

due to 200-500 white cells/cu.mm

turbid transparency of csf is due to

due to over 500 white cells/cu.mm

in acute meningitis fluid may exhibit

cloudiness/cloudy

in less acute stage of epidemic meningitis and n tuberculosis and syphilitic meningitis, tubes, poliomyelitis, and encephalitis the liquid is

clear

csf coagulation

normally doesn’t coagulate.

fluid clots

increase in proteins including fibrinogen

numerous small clots (coagulate)

occurs in paresis

“cobweb” / pine tree / “weblike” clot

occurs which may be due to TB meningitis.

where large clot is seen.

“Purulent meningitis”

heavy coagulation and sediment

occur in acute suppurative meningitis.

complete coagulation with xanthochromia w/o hemmorage

occurs in Froin’s Syndrome (spinal subarachnoid block)

test for fibrinogen

- Add 1/3 volume of NaOH to a few cc. of spinal fluid and shake, - observe for fine fibrin flocculation (condenses on surface)

sediment in fibrinogen test

Normally no sediment (often present in meningitis)

pH in fibrinogen test

Normal reaction is slightly alkaline (7.30 to 7.45 pH level)

SG in fibrinogen test

Normal SG is 1.006-1.008.

A test to confirm the presence of any subarachnoid block.

QUECKENSTEDT TEST

when both jugular is compressed in queckenstedt test it. results to

rise of CSF pressure (rapidly over 300 mm) but returns to normal when compression ceases.

where subarachnoid block at the foramen magnum

sinus thrombosis

a mass lesion at the spinal canal

foramen magnum

in sinus thrombosis the subarachnoid block at the foramen magnum (a mass lesion at the spinal canal)

the rise of CSF may be decreased or delayed.

queckenstedt test positive result

delayed or decreased rise of CSF pressure.

The protein of chief interest

globulin

Globulin test value ____ when applied to fluid containing blood.

less

Globulin is increased in

meningitis and latent syphilis.

DIFFERENT TESTS UNDER PROTEIN-GLOBULIN

A. Nonne-Apelt Test for Globulin B. Ross-Jones Test C. Pandy’s Test D. Noguchi’s Test (Qualitative Detection of Protein)

must be performed within 1⁄2 hour after fluid withdrawal

sugar test

glucose ____ on standing

gradually decomposes

glucose in spinal fluid is normally ___ of that in the blood.

60%

Qualitative Test for Sugar

Benedict's Test

Quantitative Test for Sugar.

Nelson-Somogyi Test

chlorides in spinal fluid is normally ___ higher than that in the blood.

25%

a quantitative test which procedure the same as in the chemistry procedure.

Schales and Schales Test

READING AND INTERPRETATION (SCORE OF TUBES BY THE APPEARANCE OF FLUIDE IN TUBE)

Unchanged Deep Red = 0 Red to Blue = 1 Lilac to Purple = 2 Deep Blue = 3 Pale Blue (partial precipitate) = 4 Colorless (complete) = 5

10 tubes results 0 (unchanged in color)

Normal Reaction

highest numbers on the first 3 tubes

Zone 1 or Paretic Curve

Zone 1 or Paretic Curve is related to

related to being insane or multiple myeloma

highest number on the middle tubes

Zone 2 or Tabetic Curve

Zone 2 or Tabetic Curve is related to

syphilis/syphilitic

highest numbers on the last 3 tubes

Zone 3 or Meningitic Zone

Zone 3 or Meningitic Zone is related to

TB meningitis

A TRACED OF BLOOD IN CSF MAY GIVE RISE TO

meningitis curve

BACTERIAL CONTAMINATION MAKES THE RESULT

unreliable

diluting fluid for WBC count which is composed of 1% glacial acetic acid, 99% distilled water.

tuerk's fluid

a stain used to make the cell darker and easily counted

gentian violet

normal volume of pericardial fluid

10 to 50 mL

presence of excess blood within the pericardial sac.

Pericardial effusion

pericardial fluid is produced during

inflammatory process, malignant process, and hemorrhage process.

common causes of pericardial fluid

1. Infection – such as bacterial pericarditis, TB, fungal pericarditis, and AIDS related. 2. Neoplasm – such as metastatic CA and lymphoma. 3. Hemorrhage – such as trauma, anticoagulant therapy and leakage of aortic aneurism. 4. Metabolic – such as uremia, myxedema. 5. Rheumatoid 6. MI (myocardial infarction) 7. SLE (systemic lupus erythematosus)

pericardial fluid method of collection

1. Pericardiotomy 2. Pericardiocentesis