CEREBROSPINAL FLUID IN DISEASE Flashcards by Iseoluwa Ojo

CSF-

Aka

_________

liquor cerebrospinalis

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CSF-

• Total volume in adults ≈___-____ml at rate of ____ml/day
• Ultra-filtrate of plasma from capillary walls of choroid plexuses in lateral ventricles.
• Passes through 3rd&4th ventricles into sub-arachnoid space; reabsorbed into circulation by arachnoid villi
• CSF flows slowly through Subarachnoid space (slowest in lumbar region), surrounding & in contact with cells of brain & spinal cord; acts as cushion for brain and spinal cord

135-150

500

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CSF-

•_______ of plasma from capillary walls of ________ in _______ ventricles.

Ultra-filtrate

choroid plexuses

lateral

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CSF-

• Passes through 3rd&4th ventricles into ____________; reabsorbed into circulation by _______________

sub-arachnoid space

arachnoid villi

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CSF-

CSF flows (slowly or rapidly?) through __________ space , surrounding & in contact with cells of brain & spinal cord; acts as ________ for brain and spinal cord

Slowly

Subarachnoid

cushion

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CSF-

CSF produced by modified ___________( ______ %), blood vessels and along ventricular walls

ependymal brain cells

50- 70

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CSF is the slowest in _______ region

lumbar

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CSF

•Circulates from lateral ventricles to ________ and passes through _________ to the ________, then ____________ apertures and then to __________ over the brain and spinal cord

third ventricle

cerebral aqueduct

fourth ventricle

median and lateral

subarachnoid space

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CSF

•Reabsorbed into ______ sinus blood via A__________

venous

arachnoid granulations

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CSF

Buoyancy- actual brain mass=______g; weight suspended in CSF= ___g

1400

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•CSF protects the brain from injury when jolted

T/F

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CSF

•Chemical stability- rinses ___________ of the ____________ as it is ________________ bypassing the _________

CNS tissue

metabolic waste

reabsorbed into circulation

blood brain barrier

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CSF Helps in Prevention of brain ischaemia

T/F

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Indications for CSF analysis

Meningitis/ encephalitis-_____,______,_____,______ infections

CNS/ Metastatic tumours – _________

________ in the brain and spinal cord

__________ syndrome

Unexplained cause of ______

viral, bacterial, fungal, parasitic

leukaemia

Bleeding

Gullain Barre

seizure

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Contraindications to lumber puncture

•________ skin at LP site
• ______________
•Bleeding _________
•Severe ________ disorder
•Patients with __________ deficit
•__________ state

Infected

Papilloedema

diasthesis

pulmonary

focal neurologic

Immunocompromised

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Possible complication s of lumber puncture

Post tap _______
•Vomiting
•_________ hematomas
•_________/_______ hemorrhage
•Acute ______ or _________ deterioration
•Cerebral _________
•________/_______ formation

headache

Epidural

Subdura/ subarachnoid

neurologic or respiratory

herniation

Infection/ abscess

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Collection and transport of CSF

_______ procedure via ____ , _____ puncture, shunts/ cannula by an experienced medical officer

Do a ______, if in doubt
• Inform laboratory staff and then transport the sample immediately to the lab

Aseptic ; LP; cisternal

CT scan

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Method of collecting CSF

Inform laboratory staff before performing LP

•Explain procedure to patient

•Place patient on (left or right?) side, with back on _______, fully (flexed or extended?) (——— to ———-)

•Sitting position can be used for patients with _________ or ________

Left

edge of bed

Flexed; knee to chin

pulmonary disorders or young infants

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METHOD of collecting CSF

Landmark: plane of __________ through ______________. Indent with thumbnail

•Wash hands; wear mask and sterile gloves

•Sterilize marked site with _________ or ________ in _________ ———- motion

iliac crest

L4-L5 intervertebral space

tincture of iodine

methylated spirit

circular outward

METHOD of collecting CSF

Open _________. Check _______ fittings.

Have ready properly labeled- 3 – 4 bottles: ______ bottle, ______, _______ bottle and 1 _______ bottle.

•Inject 0.25-0.5ml 1% ______ under skin at marked site
•Wait a minute, then insert spinal needle (22G,stilette in place) through mark towards ______

sterile pack; manometer

sterile ; lithium heparin, EDTA

fluoride oxalate

Lignocaine

umbilicus

METHOD of collecting CSF

Feel resistance of _______, then ______, then feel “give” as needle enters ______

•Withdraw _____. Wait for CSF
•Measure CSF pressure with manometer (90-180 mmH2O)
•Catch fluid in ____ sequentially labeled bottles(≈____ total)
•Remove needle & apply dressing to LP site

spinal ligaments; dura

SAS; stilette

3-4

5ml

Method of collecting CSF

•Lie patient ___________ for about _________ and do _____ observation and check. Ask for any headaches.
•Take venous blood sample for analysis

flat on the back

15-30minutes

CNS

LABORATO RY EXAMINATION OF CSF

Appearance
-clear and colorless: _____
-red (bloody) :_______,________
-turbid /cloudy: __________
-yellow (___________) : SAH, _____
-coagulum/viscous: ———- content (________):_____ meningitis, CNS tumor

normal

traumatic tap, SAH

acute pyogenic meningitis

Xanthochromia; jaundice

high protein

Fibrinogen ; TB

LABORATO RY EXAMINATION OF CSF

Appearance
-___________ : normal
-_____(_________) : traumatic tap, SAH
-_______/_______: acute pyogenic meningitis
-_______(Xanthochromia) : SAH, jaundice
-_________/_______: high protein content (fibrinogen): TB meningitis, CNS tumor

clear and colorless

red; bloody

turbid /cloudy

yellow

coagulum/viscous

Xanthochromia •_________________ coloured CSF •Can be due to _______/_______ •Rbc >_______/ul as seen in SAH, ICH, traumatic tap •Also can be due to increased _______ level, _______ syndrome, _______ treatment for TB

Pink/orange/yellow rbc lysis/HB breakdown 6000; bilirubin; carcinoid rifampicin

Ph of CSF: ______ Specific gravity of CSF:________

7.31-7.40 1.006-1.008

Biochemical examination (Glucose) GLUCOSE-should be approximate ___/3 of __________ level.

2 fasting plasma glucose

Biochemical examination (Glucose) GLUCOSE- A level below ___mg/dl is often associated with ________________ meningitis and in malignancy.

40 bacterial and fungal

Biochemical examination (Glucose) GLUCOSE- Glucose estimation is done in lab using the _______ or _____ method

oxidase or hexokinase

Biochemical examination LACTATE- increased level in _______________ meningitis; normal in ______ meningitis

bacterial and fungal viral

Biochemical examination LACTATE DEHYDROGENASE- elevated in ______________ meningitis, malignancy, ________ hemorrhage

bacterial and fungal subarachnoid

Biochemical examination (Proteins) More than ____% of CSF protein content originates from ______ by _____ and _______; the remainder is derived from _________

80 plasma ultrafiltration; pinocytosis intrathecal synthesis

Biochemical examination (Proteins) Protein concentration increases from (top or bottom?) (up or down?) ward the ________ region.

Top Down lumber

Biochemical examination (Proteins) Low molecular weight plasma proteins such as ______,______, and _______ normally predominate. Proteins with large Mol weight (IgG) are _________

prealbumin albumin, and transferrin not usually seen

Biochemical examination (Proteins) Break down of the blood brain barrier _____eases the presence of large MW proteins like α2- macroglobulin (AMG), fibrinogen, IgM

incr

Biochemical examination •________ and _______ ——— analysis are used to assess changes in BBB

Total and specific protein

Biochemical examination • CSF proteins usually ______ fold of protein (more or less ?) than that of plasma • Such specific proteins include ______,______,______,_______

100 Less albumin, immunoglobulins, AMG, fibrinogen

Biochemical examination • Increased BBB permeability can be assessed using _______/_______ index: < ____=Normal; ______= mild; _____= moderate; ____= Severe.

CSF/serum albumin 9 9 -14 14-30 >30

Biochemical examination • CSF Ig_____ concentration can be indicative of increased ———— or increased __________

G local production BBB permeability

Biochemical examination CSF Ig_____/_______ ratio calculated: >____ is considered indicative of increased ___________ as seen in _________

G/albumin 0.27 thecal IgG synthesis multiple sclerosis

Biochemical examination Estimation of CSF protein in the clinical laboratory is done using __________________ method __________ method _______________ can be done especially in suspected cases of _________

Sulpho salicylic acid Triacetic acid Electrophoresis Monoclonal gammopathy

HYDROCEPHA LUS •Due to _____________ •Causes infant to have ______ and other symptoms/signs – __________ eyes

blockage to CSF flow big head sun setting eyes

HYDROCEPHA LUS •Treatment is primary cause- congenital, infection •Intermittent relief through ____________

passage of shunts

Appearance of CSF in: Normal Pyogenic bacterial meningitis Viral meningitis Tuberculosis meningitis Cryptococcal meningitis

Clear and colorless Purulent and cloudy Clear or slightly turbid Clear or slightly turbid Clear or slightly turbid

Amount of WBC in CSF in: Normal Pyogenic bacterial meningitis Viral meningitis Tuberculosis meningitis Cryptococcal meningitis

Less than 5x10^6 lymphs Many pus cells Increased lymphs Increased lymphs Increased lymphs

Protein content in CSF in: Normal Pyogenic bacterial meningitis Viral meningitis Tuberculosis meningitis Cryptococcal meningitis

Normal High Normal or increased Increased Increased

Glucose content in CSF in: Normal Pyogenic bacterial meningitis Viral meningitis Tuberculosis meningitis Cryptococcal meningitis

Normal Very low Usually normal Reduced Reduced