C_Cerebral Spinal Fluid

Question 1

CSF is located between the ___ and the ___ in the brain and spinal cord.

Answer 1

arachnoid; pia mater.

Question 2

Total CSF in adults.

Answer 2

85 - 150 mL.

Question 3

Total CSF in neonates.

Answer 3

10 - 60 mL.

Question 4

What are the basic functions of CSF?

Answer 4

(1) Protect the brain and spinal cord; (2) Transport and exchange of nutrients and waste.

Question 5

How does inflammation occur in bacterial meningitis?

Answer 5

Invasion of bacteria via subarachnoid space; release of pro-inflammatory cytokines; inflammation of subarachnoid space.

Question 6

What causes cerebral swelling in bacterial meningitis?

Answer 6

Breakdown of BBB allows migration of leukocytes.

Question 7

What is the predicted CSF WBC cell count for a patient with bacterial meningitis?

Answer 7

> 1000 WBCs/mcL

Question 8

Which WBC type predominates in bacterial meningitis?

Answer 8

Neutrophil.

Question 9

What is the predicted CSF glucose for a patient with bacterial meningitis?

Answer 9

<40 mg/dL.

Question 10

What is the predicted CSF protein for a patient with bacterial meningitis?

Answer 10

> 50 mg/dL (elevated).

Question 11

What is the predicted CSF lactate for a patient with bacterial meningitis?

Answer 11

> 35 mg/dL.

Question 12

If lactate is ___ and glucose is ___, this is a good indication of bacterial meningitis.

Answer 12

increased; decreased.

Question 13

What testing technique is used for diagnosis of bacterial meningitis?

Answer 13

Latex agglutination.

Question 14

Define viral meningitis.

Answer 14

Inflammation of the lining of the brain and spinal cord due to a virus. Non-polio enteroviruses are the most common cause.

Question 15

Viral meningitis causes sensitized lymphocytes which produce cytokines which result in what?

Answer 15

Tissue destruction and further alteration of the BBB.

Question 16

What is the gold standard testing method in viral meningitis?

Answer 16

PCR.

Question 17

What is the predicted CSF WBC cell count for a patient with viral meningitis?

Answer 17

50-1000 WBC/uL.

Question 18

What WBC cell predominates in viral meningitis?

Answer 18

Lymphocyte.

Question 19

How does glucose differ from bacterial and viral meningitis?

Answer 19

Viral glucose: >45 mg/dL

Bacterial glucose: <40 mg/dL.

Question 20

What is the predicted CSF protein for a patient with viral meningitis?

Answer 20

<200 mg/dL.

Question 21

Define fungal meningitis.

Answer 21

Fungal infection of the brain and spinal cord; primarily in immunocompromised patients.

Question 22

How does clinical symptoms differ between fungal meningitis compared to bacterial or viral?

Answer 22

Slower onset of symptoms.

Question 23

What is the gold standard of fungal meningitis?

Answer 23

CSF gram stain and culture.

Question 24

What is the predicted CSF glucose for a patient with fungal meningitis?

Answer 24

> 45 mg/dL (increased).

Question 25

What is the predicted CSF protein for a patient with fungal meningitis?

Answer 25

>45 mg/dL (increased).

Question 26

What is the predicted CSF WBC count for a patient with fungal meningitis?

Answer 26

0-1000 WBCs/uL.

Question 27

Define Tuberculosis meningitis.

Answer 27

Infection of the brain and spinal cord caused by mycobacterium tuberculosis.

Question 28

What types of patients are at highest risk for tuberculosis meningitis?

Answer 28

Children and HIV patients.

Question 29

Tuberculosis meningitis typically starts as a ___ of inhalation of infectious droplets.

Answer 29

lung infection.

Question 30

What are Rich focus's?

Answer 30

Granulomas which form in the meninges, brain and/or spinal cord as a result of tuberculosis meningitis.

Question 31

What is the gold standard for diagnosing tuberculosis meningitis?

Answer 31

Culture and smear.

Question 32

What is the predicted CSF WBC count for a patient with tuberculosis meningitis?

Answer 32

50 - 500 cells/uL.

Question 33

Which cells predominate in tuberculosis meningitis?

Answer 33

Mononuclear.

Question 34

What is the predicted CSF protein for a patient with tuberculosis meningitis?

Answer 34

50 - 300 mg/dL.

Question 35

What is the predicted CSF glucose for a patient with tuberculosis meningitis?

Answer 35

<45 mg/dL.

Question 36

Define subarachnoid hemorrhage (SAH).

Answer 36

Bleeding into the subarachnoid space.

Question 37

How is SAH diagnosed?

Answer 37

Noncontrast CT scan; if negative, CSF analysis is performed.

Question 38

Xanthrochromia is (present/absent) in SAH.

Answer 38

Present.

Question 39

How would bilirubin be effected in SAH vs. traumatic puncture?

Answer 39

SAH: >350 nmol/L. Traumatic: <350 nmol/L.

Question 40

Define multiple sclerosis.

Answer 40

Chronic autoimmune disease of the central nervous system.

Question 41

How is MS commonly diagnosed?

Answer 41

Oligoclonal band analysis; compare serum and CSF samples.