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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
Cell counts are performed with
Hemacytometer
26
Normal ratio of lymphocytes to monocytes in adults and children
Adults: 70:30 Children: 30:70
27
Increased amount of normal cells
Pleocytosis
28
Pleocytosis of normal cells is valuable in determining the cause of what
Meningitis
29
Increased amounts of neutrophils =
Bacterial
30
Increased amount of lymphocytes =
Viral, tubercular, fungal, parasitic, syphilis
31
Major clinical significance if reactive lymphocytes are found
Viral, tubercular, and fungal meningitis | Multiple sclerosis
32
Major clinical significance in neutrophils with granules less prominent than blood are found
Bacterial meningitis
33
Major clinical significance if neutrophils with lens that disintegrate rapidly are found
Early cases of viral, tubercular, and fungal meningitis | Cerebral hemorrhage
34
Major clinical significance if monocytes by themselves are found
Viral, tubercular, and fungal meningitis | Multiple sclerosis
35
Clinical significance if macrophages that may contain phagocytized RBCs appearing as empty vacuoles or ghost cells, hemosiderin granules, and hematoidin crystals are found
RBCs in spinal fluid from hemorrhage | Contrast media
36
Clinical significance if lymphoblasts, myeloblasts, or monoblasts are found
Acute leukemia
37
Clinical significance if lymphoma cells with cleft nuclei are found
Disseminated lymphomas
38
Clinical significance if traditional or classic plasma cells are found
Multiple sclerosis
39
Clinical significance if eosinophils are found
Parasites | Allergic
40
Clinical significance if ependymal, choroidal, and spindle-shaped cells with distinct nuclei and cell walls are found
Diagnostic procedures
41
Clinical significance if malignant cells seen in clusters with fusing of cell borders and nuclei are found
Metatastic carcinomas | Primary central nervous system carcinoma
42
Neutrophils
43
What is present? - Primarily in bacterial meningitis - often contain phagocytized bacteria - increased early viral, fungal, tubercular, parasitic - vacuoles may be present
Neutrophils
44
Monocytes (bean-shaped) and lymphocytes (one big nucleus)
45
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
Lymphocytes and monocytes | Blanks = lymphocytes
46
Eosinophils
47
What is present? - parasitic and fungal infections (primarily Coccidioides immitis) - medications and shunts into the central nervous system
Eosinophils
48
Pink to orange fluid supernatant - breakdown of Hb
Xanthrochromia
49
18 hours for histiocytes to mobilize and phagocytose RBCs
Erythrophagocytosis
50
Product of Hb metabolism | Intracellular or extracellular
Hematoidin crystals
51
Examples of true CSF hemorrhage
Xanthrochromia, erythrophagocytosis, Hematoidin crystals
52
Erythrophagocytosis
53
Hematoidin crystals
54
Reason for a traumatic tap
Clipped blood vessel and doctor error
55
How to determine if it was a traumatic tap
- 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
Bacterial meningitis shows an increase in
Neutrophils
57
Viral, tubercular or fungal meningitis shows an increase in
Lymphocytes
58
Viral, tubercular or fungal shows an increase in
Monocytes
59
Parasitic, allergic, drug reaction shows an increase in
Eosinophils
60
What is found if a spinal tap needle penetrates vertebral bone and draws back bone marrow or an infant or adult has osteoarthritis
Hematopoietic precursors
61
Arachnoid, ependymal and choroid plexus cells can be mistaken for
Malignant cells
62
Choroid plexus cells in CSF | - no borders/open borders between cells
63
Arachnoid cell
64
Reactive lymphocytes - mononucleosis/some hepatitis - larger than normal lymphocytes, larger cytoplasm
65
Artifactual change in neutrophils
66
What is the most common yeast organism and what stain is used
Cryptococcus and you use India ink
67
What Microbio exam do you use for bacteria and fungi
Gram stain
68
What Microbio exam do you use for Cryptococcus neoformans
India ink
69
What Microbio exam do you use for tuberculosis meningitis
Acid-fast stain
70
What Microbio exam do you use for ameba Naegleria fowleri
Wright stain
71
What Microbio exam do you use to detect bacterial cause
Culture
72
Which species?
Candida albicans
73
Which species?
Cryptococcus neoformans
74
Describe malignant cells - similar to what 3 fluids - ______ cells: less ____; looks like ___ ____ - No _____ cells in CSF: presence of large _____ cells
- Plural, pericardial, peritoneal - carcinoma: cohesive; hematopoietic malignancies - mesothelial: tissue
75
Maliquant cell must be differentiated from what 3 cells
Choroid plexus cells, ependymal cells, arachnoid cells
76
What CNS diagnoses involve hematopoietic malignancies
- Leukemia: ALL, ANLL | - high grade lymphomas: lymphoblastic, immunoblastic, Burkitt lymphomas
77
Adenocarcinoma (cancer cells)
78
Small cell carcinoma
79
Acute lymphocytic leukemia
80
Normal amount of protein
15-45 mg/dL
81
Damage to the brain-blood barrier such as meningitis and hemorrhage, elevated immunoglobulins such as multiple sclerosis, and degenerate neurological tissues are indications of
Increased protein
82
How to defect oligoclonal bands
Protein electrophoresis
83
Monitors multiple sclerosis
Myelin Basic Protein
84
Used to assess permeability of blood-brain barrier
CSF/Serum albumin index
85
Normal and abnormal ranges of CSF/Serum albumin index
Normal: less than 9 Minimal impairment: 9 to 14 Moderate to severe: 15 to 100 Complete breakdown of barrier: exceeding 100
86
What four bands predominate CSF in protein electrophoresis
Transthyretin, albumin, two transferrin (one known as "tau protein")
87
Identifies oligocional bands that are present CSF but absent in serum in multiple sclerosis
Protein electrophoresis
88
Used as a marker for identifying a CSF leakage from the nose, ear, eyes or head/neck wound after injury
Tau protein (asialo-tranferrin)
89
Oligoclonal bands are seen in
Multiple sclerosis, neurological disorders including Guillain Barre, encephalitis, neurosyphilis, and in neoplastic disorders
90
Normal value of glucose in plasma
60-70%
91
Glucose test results seen in bacterial meningitis
Decreased glucose and increased WBCs and neutrophils
92
What cause a decreased glucose result
Alterations of active transport of glucose across blood-brain barrier
93
Lactate results and effect in bacterial, fungal or tuberculous infections
Lactate increased and oxygen decrease of flow to brain tissue
94
Lactate results in viral meningitis
Decreased
95
Abnormal glutamine results and symptoms/cause
Increased glutamine when ammonia level increases | Associated with loss of consciousness or coma and liver disorders
96
Immunologic test for neurosyphilis
VDRL
97
Immunologic test for bacterial and fungal organizations
Assays

CLS 304 (8 decks)

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