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CLS 304 > Chapter 13 Cerebrospinal Fluid > Flashcards

Chapter 13 Cerebrospinal Fluid Flashcards

1
Q

Clear, colorless liquid formed in the 4 ventricles of the brain by secretion from the choroid plexus and a smaller contribution from the ependymal cells that line the brain and spinal cord

A

Cerebrospinal fluid (CSF)

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2
Q

What does CSF do

A
  • Supplies nutments to nervous tissue
  • removes metabolic waste
  • Produces a mechanical barrier to protect and cushion the brain and spinal cord
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3
Q

Central nervous system consists of

A

Brain and spinal cord

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4
Q

What 3 membranes line the central nervous system and what layer are they?

A
  • Dura mater (outer layer)
  • Arachnoid mater (middle layer)
  • Pia mater (inner layer)
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5
Q

CSF flows between which layers

A

Arachnoid mater and pia mater

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6
Q

How is CSF produced?

A

By choroid plexus cells and ependymal lining cells (blood-brain barrier)

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7
Q

Where does CSF circulate

A

Through the ventricular system: cerebrum, brain stem, completely covers surface of brain and spinal cord

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8
Q

Name the 6 structures

A 
From superior to inferior:
Skull
Dura mater
Subdural space
Arachnoid
Subarachnoid space
Pia mater
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9
Q

Total volume of CSF in adults and neonates

A

Adults: 85-150ml
Neonates: 10-60ml

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10
Q

Pathologic alterations of CSF are caused in

A

Infections (meningitis), cerebral hemorrhage, tumors, leukemia, syphilis, demyelinating diseases (multiple sclerosis), and other blood-brain barrier conditions

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11
Q

Blockage of drainage of CSF can be caused by

A

Tumor, inflammation, developmental malformation, meningitis, hemorrhage or injury

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12
Q

Continued production of CSF causing an increase in pressure

A

Hydrocephalus

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13
Q

How many tubes are used for collection of CSF and where are they sent?

A

3 tubes (additional sometimes submitted):

  • tube 1 for chemistry and immunology (can be frozen)
  • tube 2 for microbiology (keep at room temp)
  • tube 3 for hematology and cytology (can be refrigerated)
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14
Q

If there is only a small volume of CSF what testing is priority?

A

Micro and cellular

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15
Q

What do you do if you receive a sample that is not labeled

A

Run the test and then contact nurse. Sample can go bad and diagnosis could be contagious

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16
Q

If blood distribution in CSF sample is even

A

Hemorrhage

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17
Q

If blood in CSF sample is uneven

A

Traumatic tap

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18
Q

Cause, and significance if sample is crystal clear

A

Cause: normal
Significance: normal

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19
Q

Cause, and significance if sample is hazy, turbid, cloudy, milky, viscous

A

Cause: WBCs, Microorganisms, protein
Significance: meningitis, brain-blood barrier disorders, IgG production within CNS, mucin adenocarcinomas

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20
Q

Cause, and significance of bloody sample

A

Cause: RBCs
Significance: hemorrhage, traumatic tap

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21
Q

Cause, and significance of xanthochromic sample

A

Cause: hemoglobin, bilirubin, carotene, melanin
Significance: Old hemorrhage, RBC degradation, bilirubin

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22
Q

Cause, and significance of clotted sample

A

Cause: protein, fibrinogen
Significance: brain-blood barrier disorders, traumatic tap

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23
Q

Cause, and significance of pellicle sample

A

Cause: protein, clotting factors
Significance: tubercular meningitis

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24
Q

Normal amount of WBCs and RBCs

A

WBC: 0-5 per microliter (specifically lymphocytes and monocytes)
RBC: not present

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25
Q

Cell counts are performed with

A

Hemacytometer

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26
Q

Normal ratio of lymphocytes to monocytes in adults and children

A

Adults: 70:30
Children: 30:70

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27
Q

Increased amount of normal cells

A

Pleocytosis

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28
Q

Pleocytosis of normal cells is valuable in determining the cause of what

A

Meningitis

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29
Q

Increased amounts of neutrophils =

A

Bacterial

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30
Q

Increased amount of lymphocytes =

A

Viral, tubercular, fungal, parasitic, syphilis

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31
Q

Major clinical significance if reactive lymphocytes are found

A

Viral, tubercular, and fungal meningitis

Multiple sclerosis

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32
Q

Major clinical significance in neutrophils with granules less prominent than blood are found

A

Bacterial meningitis

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33
Q

Major clinical significance if neutrophils with lens that disintegrate rapidly are found

A

Early cases of viral, tubercular, and fungal meningitis

Cerebral hemorrhage

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34
Q

Major clinical significance if monocytes by themselves are found

A

Viral, tubercular, and fungal meningitis

Multiple sclerosis

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35
Q

Clinical significance if macrophages that may contain phagocytized RBCs appearing as empty vacuoles or ghost cells, hemosiderin granules, and hematoidin crystals are found

A

RBCs in spinal fluid from hemorrhage

Contrast media

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36
Q

Clinical significance if lymphoblasts, myeloblasts, or monoblasts are found

A

Acute leukemia

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37
Q

Clinical significance if lymphoma cells with cleft nuclei are found

A

Disseminated lymphomas

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38
Q

Clinical significance if traditional or classic plasma cells are found

A

Multiple sclerosis

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39
Q

Clinical significance if eosinophils are found

A

Parasites

Allergic

40
Q

Clinical significance if ependymal, choroidal, and spindle-shaped cells with distinct nuclei and cell walls are found

A

Diagnostic procedures

41
Q

Clinical significance if malignant cells seen in clusters with fusing of cell borders and nuclei are found

A

Metatastic carcinomas

Primary central nervous system carcinoma

42
Q
A

Neutrophils

43
Q

What is present?

  • Primarily in bacterial meningitis
  • often contain phagocytized bacteria
  • increased early viral, fungal, tubercular, parasitic
  • vacuoles may be present
A

Neutrophils

44
Q
A

Monocytes (bean-shaped) and lymphocytes (one big nucleus)

45
Q

What is present?

  • viral, fungal, tubercular
  • Reactive ________ with viral
  • multiple sclerosis has 50 or fewer ______ per microliter, both normal and reactive
  • seen in HIV and AIDS
A

Lymphocytes and monocytes

Blanks = lymphocytes

46
Q
A

Eosinophils

47
Q

What is present?

  • parasitic and fungal infections (primarily Coccidioides immitis)
  • medications and shunts into the central nervous system
A

Eosinophils

48
Q

Pink to orange fluid supernatant - breakdown of Hb

A

Xanthrochromia

49
Q

18 hours for histiocytes to mobilize and phagocytose RBCs

A

Erythrophagocytosis

50
Q

Product of Hb metabolism

Intracellular or extracellular

A

Hematoidin crystals

51
Q

Examples of true CSF hemorrhage

A

Xanthrochromia, erythrophagocytosis, Hematoidin crystals

52
Q
A

Erythrophagocytosis

53
Q
A

Hematoidin crystals

54
Q

Reason for a traumatic tap

A

Clipped blood vessel and doctor error

55
Q

How to determine if it was a traumatic tap

A
  • total RBC count significantly higher in 1st tube than last
  • WBC and RBC counts reflect same ratio as PB
  • 1 to 2 WBCs for every 1000 RBCs
56
Q

Bacterial meningitis shows an increase in

A

Neutrophils

57
Q

Viral, tubercular or fungal meningitis shows an increase in

A

Lymphocytes

58
Q

Viral, tubercular or fungal shows an increase in

A

Monocytes

59
Q

Parasitic, allergic, drug reaction shows an increase in

A

Eosinophils

60
Q

What is found if a spinal tap needle penetrates vertebral bone and draws back bone marrow or an infant or adult has osteoarthritis

A

Hematopoietic precursors

61
Q

Arachnoid, ependymal and choroid plexus cells can be mistaken for

A

Malignant cells

62
Q
A

Choroid plexus cells in CSF

- no borders/open borders between cells

63
Q
A

Arachnoid cell

64
Q
A

Reactive lymphocytes

  • mononucleosis/some hepatitis
  • larger than normal lymphocytes, larger cytoplasm
65
Q
A

Artifactual change in neutrophils

66
Q

What is the most common yeast organism and what stain is used

A

Cryptococcus and you use India ink

67
Q

What Microbio exam do you use for bacteria and fungi

A

Gram stain

68
Q

What Microbio exam do you use for Cryptococcus neoformans

A

India ink

69
Q

What Microbio exam do you use for tuberculosis meningitis

A

Acid-fast stain

70
Q

What Microbio exam do you use for ameba Naegleria fowleri

A

Wright stain

71
Q

What Microbio exam do you use to detect bacterial cause

A

Culture

72
Q

Which species?

A

Candida albicans

73
Q

Which species?

A

Cryptococcus neoformans

74
Q

Describe malignant cells

  • similar to what 3 fluids
  • ______ cells: less ____; looks like ___ ____
  • No _____ cells in CSF: presence of large _____ cells
A
  • Plural, pericardial, peritoneal
  • carcinoma: cohesive; hematopoietic malignancies
  • mesothelial: tissue
75
Q

Maliquant cell must be differentiated from what 3 cells

A

Choroid plexus cells, ependymal cells, arachnoid cells

76
Q

What CNS diagnoses involve hematopoietic malignancies

A
  • Leukemia: ALL, ANLL

- high grade lymphomas: lymphoblastic, immunoblastic, Burkitt lymphomas

77
Q
A

Adenocarcinoma (cancer cells)

78
Q
A

Small cell carcinoma

79
Q
A

Acute lymphocytic leukemia

80
Q

Normal amount of protein

A

15-45 mg/dL

81
Q

Damage to the brain-blood barrier such as meningitis and hemorrhage, elevated immunoglobulins such as multiple sclerosis, and degenerate neurological tissues are indications of

A

Increased protein

82
Q

How to defect oligoclonal bands

A

Protein electrophoresis

83
Q

Monitors multiple sclerosis

A

Myelin Basic Protein

84
Q

Used to assess permeability of blood-brain barrier

A

CSF/Serum albumin index

85
Q

Normal and abnormal ranges of CSF/Serum albumin index

A

Normal: less than 9
Minimal impairment: 9 to 14
Moderate to severe: 15 to 100
Complete breakdown of barrier: exceeding 100

86
Q

What four bands predominate CSF in protein electrophoresis

A

Transthyretin, albumin, two transferrin (one known as “tau protein”)

87
Q

Identifies oligocional bands that are present CSF but absent in serum in multiple sclerosis

A

Protein electrophoresis

88
Q

Used as a marker for identifying a CSF leakage from the nose, ear, eyes or head/neck wound after injury

A

Tau protein (asialo-tranferrin)

89
Q

Oligoclonal bands are seen in

A

Multiple sclerosis, neurological disorders including Guillain Barre, encephalitis, neurosyphilis, and in neoplastic disorders

90
Q

Normal value of glucose in plasma

A

60-70%

91
Q

Glucose test results seen in bacterial meningitis

A

Decreased glucose and increased WBCs and neutrophils

92
Q

What cause a decreased glucose result

A

Alterations of active transport of glucose across blood-brain barrier

93
Q

Lactate results and effect in bacterial, fungal or tuberculous infections

A

Lactate increased and oxygen decrease of flow to brain tissue

94
Q

Lactate results in viral meningitis

A

Decreased

95
Q

Abnormal glutamine results and symptoms/cause

A

Increased glutamine when ammonia level increases

Associated with loss of consciousness or coma and liver disorders

96
Q

Immunologic test for neurosyphilis

A

VDRL

97
Q

Immunologic test for bacterial and fungal organizations

A

Assays

CLS 304 (8 decks)

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