C_Cerebral Spinal Fluid Flashcards
CSF is located between the ___ and the ___ in the brain and spinal cord.
arachnoid; pia mater.
Total CSF in adults.
85 - 150 mL.
Total CSF in neonates.
10 - 60 mL.
What are the basic functions of CSF?
(1) Protect the brain and spinal cord; (2) Transport and exchange of nutrients and waste.
How does inflammation occur in bacterial meningitis?
Invasion of bacteria via subarachnoid space; release of pro-inflammatory cytokines; inflammation of subarachnoid space.
What causes cerebral swelling in bacterial meningitis?
Breakdown of BBB allows migration of leukocytes.
What is the predicted CSF WBC cell count for a patient with bacterial meningitis?
> 1000 WBCs/mcL
Which WBC type predominates in bacterial meningitis?
Neutrophil.
What is the predicted CSF glucose for a patient with bacterial meningitis?
<40 mg/dL.
What is the predicted CSF protein for a patient with bacterial meningitis?
> 50 mg/dL (elevated).
What is the predicted CSF lactate for a patient with bacterial meningitis?
> 35 mg/dL.
If lactate is ___ and glucose is ___, this is a good indication of bacterial meningitis.
increased; decreased.
What testing technique is used for diagnosis of bacterial meningitis?
Latex agglutination.
Define viral meningitis.
Inflammation of the lining of the brain and spinal cord due to a virus. Non-polio enteroviruses are the most common cause.
Viral meningitis causes sensitized lymphocytes which produce cytokines which result in what?
Tissue destruction and further alteration of the BBB.
What is the gold standard testing method in viral meningitis?
PCR.
What is the predicted CSF WBC cell count for a patient with viral meningitis?
50-1000 WBC/uL.
What WBC cell predominates in viral meningitis?
Lymphocyte.
How does glucose differ from bacterial and viral meningitis?
Viral glucose: >45 mg/dL
Bacterial glucose: <40 mg/dL.
What is the predicted CSF protein for a patient with viral meningitis?
<200 mg/dL.
Define fungal meningitis.
Fungal infection of the brain and spinal cord; primarily in immunocompromised patients.
How does clinical symptoms differ between fungal meningitis compared to bacterial or viral?
Slower onset of symptoms.
What is the gold standard of fungal meningitis?
CSF gram stain and culture.
What is the predicted CSF glucose for a patient with fungal meningitis?
> 45 mg/dL (increased).
What is the predicted CSF protein for a patient with fungal meningitis?
> 45 mg/dL (increased).
What is the predicted CSF WBC count for a patient with fungal meningitis?
0-1000 WBCs/uL.
Define Tuberculosis meningitis.
Infection of the brain and spinal cord caused by mycobacterium tuberculosis.
What types of patients are at highest risk for tuberculosis meningitis?
Children and HIV patients.
Tuberculosis meningitis typically starts as a ___ of inhalation of infectious droplets.
lung infection.
What are Rich focus’s?
Granulomas which form in the meninges, brain and/or spinal cord as a result of tuberculosis meningitis.
What is the gold standard for diagnosing tuberculosis meningitis?
Culture and smear.
What is the predicted CSF WBC count for a patient with tuberculosis meningitis?
50 - 500 cells/uL.
Which cells predominate in tuberculosis meningitis?
Mononuclear.
What is the predicted CSF protein for a patient with tuberculosis meningitis?
50 - 300 mg/dL.
What is the predicted CSF glucose for a patient with tuberculosis meningitis?
<45 mg/dL.
Define subarachnoid hemorrhage (SAH).
Bleeding into the subarachnoid space.
How is SAH diagnosed?
Noncontrast CT scan; if negative, CSF analysis is performed.
Xanthrochromia is (present/absent) in SAH.
Present.
How would bilirubin be effected in SAH vs. traumatic puncture?
SAH: >350 nmol/L.
Traumatic: <350 nmol/L.
Define multiple sclerosis.
Chronic autoimmune disease of the central nervous system.
How is MS commonly diagnosed?
Oligoclonal band analysis; compare serum and CSF samples.
