AUBF-Lab-CSF Flashcards by vnlla babe

_____ is a clear, colorless fluid formed within the cavities (ventricle of the brain).

Cerebrospinal fluid (CSF)

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The _______ produces about 70% of the CSF by ultrafiltration and secretion.

choroids plexus

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The _______ and ______ produce the remainder of the CSF total volume.

ependymal lining of the ventricles and cerebral subarachnoid space

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Approximately _____ of CSF fluid is formed per day, although only ______ is present in the system at any one time.

500ml; 90 to 150ml

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Reabsorption of CSF occurs at the ______.

arachnoid villi

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The initial appearance of the normally _____ can provide valuable diagnostic information.

crystal clear CSF

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: What are the causes of Crystal, Clear

WBCs
RBCs
Microorganisms
Protein

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Crystal, Clear Major Significance

Traumatic tap
Disorders that affect blood-brain barrier,
Production of IgG within the CNS

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Oily causes

Radiographic contrast media

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Bloody causes

RBCs

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Bloody Major Significance

Hemorrhage, Traumatic tap

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Xanthochromic causes

Hemoglobin, Bilirubin,
Carotene, Protein, Melanin

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Xanthochromic Major Significance

Old hemorrhage
Lysed cells from tap RBC degredation,
Elevated serum bilirubin levels,
Increased carotene blood levels
Meningeal sarcoma

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Clotted causes

Protein, Clotting factors

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Clotted Major Significance

Traumatic tap

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Pellicle causes

Protein, Clotting factors

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CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Pellicle Major Significance

Traumatic tap Disorders

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The CSF normally contains very little protein because the protein in the blood does not cross the ______ easily.

blood-brain barrier

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Protein concentration normally increases _____ from the ventricles to the cisterns and finally to the lumbar sac.

caudally

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Protein concentration normally increases caudally from the ______ to the _____ and finally to the ______.

ventricles; cisterns; lumbar sac

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The ______ is a nonspecific but reliable indication of CNS pathology such as meningitis, brain abscess, MS, and the other degenerative processes causing neoplastic disease.

CSF protein

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Elevated CSF protein levels may be caused by (4)

increased permeability of the blood-brain barrier
decreased reabsorption of the arachnoid villi
mechanical obstruction of the CSF flow
increased intrathecal immunologic synthesis.

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Normal value Reference (Quantitative) of Protein in CSF:
Adults: ________ (lumbar)
_______ (cisternal)
________ (ventricular)
Neonates: ______ (lumbar)
Elderly: (>60y.o) : ________

Adults: 15-45 mg/dl (lumbar)
15-25 mg/dl (cisternal)
5-15 mg/dl (ventricular)
Neonates: 15-100 mg/dl (lumbar)
Elderly: (>60y.o) : 15-60 mg/dl

What are the tests for detection of Protein in CSF

Pandy’s Test
Ross-Jones Test
Tryptophan

Principle of Pandy's Test:

The reagent precipitates albumin and globulin

Procedure of Pandy's test

1. Place 1ml of saturated aqueous solution of phenol in a small test tube 2. Add 1 large drop of spinal fluid

Positive result of Pandy's test

A bluish white cloud immediately forms as soon as the drop mixes with the reagent

Principle of Ross-Jones Test

This is Nonne-Apelt reaction

Procedure of Ross-Jones Test

In a small test tube, 1ml of a saturated solution of ammonium sulfate is carefully overlaid (may use this amount when necessary) with 1ml of the spinal fluid to be tested

Positive Result of Ross-Jones Test

1+: A thin white ring may be seen at the zone of contact within three minutes and which disappears on mixing 4+: A heavy cloud which does not appear on mixing

Procedure of Tryptophan

1. Place 1ml of clear spinal fluid in a test tube 2. Add 5ml of concentrated HCI and drop 2% solution of formaldehyde (freshly prepared from a stock of 40% solution) 3. Mix and let stand for 5mins 4. Carefully overlay with 1.2ml of 0.06% solution of sodium nitrate (freshly prepared from a stock of 0.6% solution) 5. Read after 3mins

The CSF glucose level varies with the ______.

blood glucose levels

The CSF glucose level varies with the blood glucose levels. It is usually about _____ of the blood glucose level.

60%

A blood glucose specimen should be obtained at least_____ before lumbar puncture for comparisons.

60 minutes

A blood glucose specimen should be obtained at least 60 minutes before ______ for comparisons.

lumbar puncture

Any changes in the blood sugar are reflected in the CSF approximately ______ because of the lag in CSF glucose equilibrium time.

1 hour later

Any changes in the blood sugar are reflected in the CSF approximately 1 hour later because of the lag in _____

CSF glucose equilibrium time.

This measurement is helpful in determining impaired transport of glucose from plasma to CSF, increased use of glucose in the CNS and glucose utilization by leukocytes and microorganisms, the finding of a markedly decreased CSF glucose level accompanied by an increased WBC count with a large percentage of neutrophils is indicative of _______

bacterial meningitis

Normal Reference Values of Glucose in CSF: Adult: _____ Child: _____ CSF-to-plasma glucose level ratio : _____ CSF glucose level: _______

Adult: 40-70mg/dl or 2.2-3.9 mmol/L Child: 60-80 mg/dl or 3.3-4.4 mmol/L CSF-to-plasma glucose level ratio : <0.5 CSF glucose level: 60%-70% of blood glucose level

Test for determining Glucose in CSF

Benedict's Test

Benedict's Test procedure

1. Place 0.5ml of Benedict's qualitative reagent to a test tube 2. Add 4.5cc of distilled water 3. Heat to boiling 4. Add 1cc of spinal fluid 5. Boil again for 1-2minutes 6. Allow to cool

Results of Benedict's Test: Normal sugar in CSF: _____ Absence of sugar (pathological): ______ Excess of protein but no sugar: ______

Normal sugar in CSF: turbid greenish yellow Absence of sugar (pathological): no change in color Excess of protein but no sugar: deep purplish violet or pinkish-violet color

Normal CSF contains a small number of _____ and _____ in a ratio of approximately 70:30 in adults.

lymphocytes and monocytes

Normal CSF contains a small number of lymphocytes and monocytes in a ratio of approximately _______ in adults.

70:30

A higher proportion of monocytes is present in ______

young children.

An increase in the number of white blood cells (WBCs) in CSF is termed _______.

pleocytosis

CSF is examined for the presence of _____ and ____.

RBCs and WBCs

In general, (3) cause an elevated WBC count.

inflammatory disease hemorrhage neoplasms trauma

Normal Reference Values of WBCs in CSF: ** Normal CSF is essentially _____ Adults: _______ Newborns: ________ Child: _______

Normal Reference Values: ** Normal CSF is essentially free of cells Adults: 0-5 WBCs/ul or 5 x 106 WBCs/L Newborns: 0-30 WBCs/ul or 0-30 x 106 WBCs/L Child: 0-15 WBCs/ul or 0-15 x 106 WBCs/L

NORMAL CELL COUNT: Lymphocytes ADULTS: NEWBORN:

40% - 80% 5%-35%

NORMAL CELL COUNT: Monocytes ADULTS: NEWBORN:

15% -45% 50%-90%

NORMAL CELL COUNT: Polys (Neutrophils) ADULTS: NEWBORN:

0% - 6% 0% - 8%

**Use tube _____ for counting the cells present in the CSF sample.

A. Total Leukocyte Count ** Mixture of fresh blood interferes with cell counts. The larger the mixture, the greater______ the error. In almost every case, ______ are due to traumatic bleeding caused home while obtaining the fluid.

greater; "bloody taps"

Total Leukocyte Count Procedure

1. Tube 3 is thoroughly shaken (replace the cotton plug with a rubber stopper) and with the aid of capillary pipette provided with a rubber bulb 2. Mount a drop of fluid on an Improved Neubauer hemocytometer counting chamber 3. Count the number of WBCs on the 4 large corner squares and the RBCs on the 5 smaller squares of the central square 4. Compute the results. Use the same formula used to obtain WBC and RBC counts

Computation for WBC ct? RBC ct?

WBC ct = Cells counted x ACF x DCF x DF (106/L) RBC ct = Cells counted x ACF x DCF x DF (106/L)