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House Clinical Pathology > CEREBROSPINAL FLUID IN DISEASE > Flashcards

CEREBROSPINAL FLUID IN DISEASE Flashcards

1
Q

CSF-

Aka

_________

A

liquor cerebrospinalis

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2
Q

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

A

135-150

500

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3
Q

CSF-

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

A

Ultra-filtrate

choroid plexuses

lateral

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4
Q

CSF-

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

A

sub-arachnoid space

arachnoid villi

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5
Q

CSF-

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

A

Slowly

Subarachnoid

cushion

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6
Q

CSF-

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

A

ependymal brain cells

50- 70

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7
Q

CSF is the slowest in _______ region

A

lumbar

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8
Q

CSF

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

A

third ventricle

cerebral aqueduct

fourth ventricle

median and lateral

subarachnoid space

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9
Q

CSF

•Reabsorbed into ______ sinus blood via A__________

A

venous

arachnoid granulations

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10
Q

CSF

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

A

1400

25

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11
Q

•CSF protects the brain from injury when jolted

T/F

A

T

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12
Q

CSF

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

A

CNS tissue

metabolic waste

reabsorbed into circulation

blood brain barrier

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13
Q

CSF Helps in Prevention of brain ischaemia

T/F

A

T

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14
Q

Indications for CSF analysis

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

CNS/ Metastatic tumours – _________

________ in the brain and spinal cord

__________ syndrome

Unexplained cause of ______

A

viral, bacterial, fungal, parasitic

leukaemia

Bleeding

Gullain Barre

seizure

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15
Q

Contraindications to lumber puncture

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

A

Infected

Papilloedema

diasthesis

pulmonary

focal neurologic

Immunocompromised

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16
Q

Possible complication s of lumber puncture

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

A

headache

Epidural

Subdura/ subarachnoid

neurologic or respiratory

herniation

Infection/ abscess

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17
Q

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

A

Aseptic ; LP; cisternal

CT scan

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18
Q

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 ________

A

Left

edge of bed

Flexed; knee to chin

pulmonary disorders or young infants

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19
Q

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

A

iliac crest

L4-L5 intervertebral space

tincture of iodine

methylated spirit

circular outward

20
Q

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 ______

A

sterile pack; manometer

sterile ; lithium heparin, EDTA

fluoride oxalate

Lignocaine

umbilicus

21
Q

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

A

spinal ligaments; dura

SAS; stilette

3-4

5ml

22
Q

Method of collecting CSF

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

A

flat on the back

15-30minutes

CNS

23
Q

LABORATO RY EXAMINATION OF CSF

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

A

normal

traumatic tap, SAH

acute pyogenic meningitis

Xanthochromia; jaundice

high protein

Fibrinogen ; TB

24
Q

LABORATO RY EXAMINATION OF CSF

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

A

clear and colorless

red; bloody

turbid /cloudy

yellow

coagulum/viscous

25
Q

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

A

Pink/orange/yellow

rbc lysis/HB breakdown

6000; bilirubin; carcinoid

rifampicin

26
Q

Ph of CSF: ______

Specific gravity of CSF:________

A

7.31-7.40

1.006-1.008

27
Q

Biochemical examination (Glucose)

GLUCOSE-should be approximate ___/3 of __________ level.

A

2

fasting plasma glucose

28
Q

Biochemical examination (Glucose)

GLUCOSE-

A level below ___mg/dl is often associated with ________________ meningitis and in malignancy.

A

40

bacterial and fungal

29
Q

Biochemical examination (Glucose)

GLUCOSE-

Glucose estimation is done in lab using the _______ or _____ method

A

oxidase or hexokinase

30
Q

Biochemical examination

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

A

bacterial and fungal

viral

31
Q

Biochemical examination

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

A

bacterial and fungal

subarachnoid

32
Q

Biochemical examination (Proteins)

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

A

80

plasma

ultrafiltration; pinocytosis

intrathecal synthesis

33
Q

Biochemical examination (Proteins)

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

A

Top

Down

lumber

34
Q

Biochemical examination (Proteins)

Low molecular weight plasma proteins such as ______,______, and _______ normally predominate.

Proteins with large Mol weight (IgG) are _________

A

prealbumin albumin, and transferrin

not usually seen

35
Q

Biochemical examination (Proteins)

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

A

incr

36
Q

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

A

Total and specific protein

37
Q

Biochemical examination

• CSF proteins usually ______ fold of protein (more or less ?) than that of plasma

• Such specific proteins include ______,______,______,_______

A

100

Less

albumin, immunoglobulins, AMG, fibrinogen

38
Q

Biochemical examination

• Increased BBB permeability can be assessed using _______/_______ index:

< ____=Normal; ______= mild; _____= moderate; ____= Severe.

A

CSF/serum albumin

9

9 -14

14-30

> 30

39
Q

Biochemical examination

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

A

G

local production

BBB permeability

40
Q

Biochemical examination

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

A

G/albumin

0.27

thecal IgG synthesis

multiple sclerosis

41
Q

Biochemical examination

Estimation of CSF protein in the clinical laboratory is done using

__________________ method

__________ method

_______________ can be done especially in suspected cases of _________

A

Sulpho salicylic acid

Triacetic acid

Electrophoresis

Monoclonal gammopathy

42
Q

HYDROCEPHA LUS

•Due to _____________

•Causes infant to have ______ and other symptoms/signs – __________ eyes

A

blockage to CSF flow

big head

sun setting eyes

43
Q

HYDROCEPHA LUS

•Treatment is primary cause- congenital, infection

•Intermittent relief through ____________

A

passage of shunts

44
Q

Appearance of CSF in:

Normal
Pyogenic bacterial meningitis
Viral meningitis
Tuberculosis meningitis
Cryptococcal meningitis

A

Clear and colorless

Purulent and cloudy

Clear or slightly turbid

Clear or slightly turbid

Clear or slightly turbid

45
Q

Amount of WBC in CSF in:

Normal
Pyogenic bacterial meningitis
Viral meningitis
Tuberculosis meningitis
Cryptococcal meningitis

A

Less than 5x10^6 lymphs

Many pus cells

Increased lymphs

Increased lymphs

Increased lymphs

46
Q

Protein content in CSF in:

Normal
Pyogenic bacterial meningitis
Viral meningitis
Tuberculosis meningitis
Cryptococcal meningitis

A

Normal

High

Normal or increased

Increased

Increased

47
Q

Glucose content in CSF in:

Normal
Pyogenic bacterial meningitis
Viral meningitis
Tuberculosis meningitis
Cryptococcal meningitis

A

Normal

Very low

Usually normal

Reduced

Reduced

House Clinical Pathology (45 decks)

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