CSF Flashcards
CSF is first recognized by
Cotugno(1764)
CSF is
third major body component
Functions of csf
Supply nutrients to CNS
Remove metabolic wastes
Mechanical barrier
csf is produced by
Choroid Plexuses of the
2 lumbar ventricles
3rd ventricle
4th ventricle
csf is Reabsorbed in
blood capillaries in the Arachnoid Villi/Granulation
TOTAL VOLUME (ADULT)
90-150 mL
TOTAL VOLUME (NEONATES)
10-60 mL
RATE OF REABSORPTION/production
20 mL
tight-fitting junctures of endothelial cells in choroid plexuses that prevent passage of many molecules
Blood-Brain Barrier
20 mL collected through
lumbar puncture
Site of collection: (between) of csf
third and fourth OR fourth and fifth lumbar vertebra
Tube 1
chemistry/serology;freezing
tube 2
microbiology; RT
tube 3
hematology, RT
tube 4
ADDITIONAL TEST
if one tube only
- Microbiology
- Hematology
- Chemistry or Serology
- Other Tests
color of csf
colorless
viscosity of csf
same with water
clarity of csf
crystal clear
S.G of csf
1.006-1.008
pH of csf
7.30-7.35
pressure of csf
50 to 200 mm H20
SLIGHTLY HAZY
200-500 wbc/uL
cloudy
> 500 wbc/uL
turbid/milky
wbc,rbc,proteins, increased lipid concentration, microorganisms, aspirated epidurial fats, radiographic contrast media
CLOTTED
FROIN’S DISEASE
BLOODY
hemorrhage
VISCOUS
CRYPTOCCOCAL MENINGITIS
OILY
radiographic contrast media
PELLICLE FORMATION
tubercular Meningitis/ web-like upon refrigeration
Xanthochroma
presence of RBC degradation product
NORMAL CSF WBC COUNTS: adults
0-5 wbc/uL
NORMAL CSF WBC COUNTS: children
higher values
NORMAL CSF WBC COUNTS:neonates
0-30 mononuclears/uL
Slightly hazy
1:10
hazy
1:20
Slightly Cloudy
1:100
Slightly Bloody or Cloudy
1:200
Bloody or Turbid
1:10,100
wbc for every 700 rbc seen
-1
mg/dL TP concentration for every 1,200 RBC/uL
-1
mg/dL TP concentration for every 10,000 RBC/uL
-8
When performing differential count, the specimen should be:
1st: Concentrated
2nd: Smeared
3rd: Stained
methods of centrifugation
1.sedimentation
2.centrifugation (5-10 min)
3. cytocentrifugation
cytocentrifugation has
0.1 mL of CSF + 30%albumin
Result: ↑cell yield;↓cellular distortion
L: M RATIO IN ADULTS
70:30
L:M RATIO IN INFANTS
30:70
increased number of normal cells an ABNORMAL state
pleocystosis
protein normal values: adults
15-45mg/dL
protein normal values: infants
150 mg/dL
protein normal values: immature
500 mg/dL
Alpha-globulins
Haptoglobin
Ceruloplasmin
Beta-globulins
Beta-2 Transferrin/Tau Protein
gamma-globulin
IgG and some IgA
not found in normal csf
IgA,IgM, IgA, beta-lipoprotein,fibrinogen
2 methods in protein determination
turbidimetry production and dye binding
adapted in automated instrumentation in the form of NEPHELOMETRY
turbidimetry method
precipitates BOTH albumin & globulin;most preferred method
trichloroacetic acid (3%)
precipitates albumin ONLY; to precipitate globulins, add sodium sulfate
bSulfosalicylic Acid (3% SSA)
dye-binding
Dye: Coomasie Brilliant Blue
protein binds to dye (red to blue)
Result: ↑protein = ↑ blue color
Evaluates BBB integrity
CSF/SERUM ALBUMIN INDEX
normal index value
<9 = intact rbc
9-14 index
SLIGHTLY IMPAIRMENT
5-30 INDEX
MODERATE IMPARTMENT
> 30
SEVERE IMPARTMENT
100 INDEX
COMPLETE DAMEGE
Measures IgG synthesis within the CNS
CSF IgG INDEX
NORMAL CSF IGg INDEX
<0.77
IGg PRODUCTION WITHIN CNS
> 0.77
METHOD OF CHOICE when it is necessary to determine if the fluid is CSF.
Tau identification’ Beta2-transferrin
a demyelinating disorder
multiple sclerosis
findings in multiple sclerosis
Findings:
✓ (+) Anti-myelin Sheath Autoantibody
✓ (+) Oligoclonal band in CSF but not in serum
✓ (+) Myelin Basic Protein
✓ ↑ IgG Index
protein component of lipid protein complex that isolates the nerve fibers; presence of this in csf indicates destruction of myelin sheaths used to measure multiple sclerosis
MBP (myelin basic proteins)
oligoclonal banding in csf NOT in serum
Multiple Sclerosis
Neurosyphilis
Encephalitis
Neoplastic disorder
Guillaine-Barre Syndrome
oligoclonal bonding in serum NOT IN CSF
Leukemia
Lymphoma
Viral Infection
oligoclonal banding in serum and csf
HIV
NORMAL VALUE OF GLUCOSE
50-80 mg/dL (60-70%)
glucose is normal in
viral meningitis
normal value for lactate
10-22 mg/dL
lactate is elevated in
bacterial meningitis (>35 mg/dL)
tubercular menigitis (25mg/dL)
hypoxia
lactate is normal in
viral meningitis
glutamine product
ammonia
a-ketoglutarate
Indirect test for the presence of excess ammonia in the CSF;
glutamine
NORMAL VALUE OF GLUTAMINE
8-18mg/dL
other name for glutamine
Reye’s syndrome
normal serum ldh
2>1>3>4>5
flipped pattern: 1>2>3>4>5
normal csf ldh
1>2>3>4>5
neurological abnormalities: 2>1>3>4>5
bacterial meningitis: 5>4>3>2>1
CSF LDH Isoenzymes:
1 and 2 = BRAIN TISSUES
2 and 3 = Lymphocytes
4and 5 = Neutrophils
CK ELEVATED IN:
Stroke
MS
degenerative disorders
brain tumors
viral & bacterial meningitis
seizures
if ↑ in post-cardiac arrest patients if CK-BB BRAIN;CK MB-HEART;CK-MM S MUSCLES (<17 mg/dL) [recovery]
POOR CARDIAC ARREST PATIENTS –> POOR PROGNOSIS
AST is elevated in
intracerebral hemorrhage
subarachnoid hemorrhage
bacterial meningitis
recommended by CDC for the detection of NEUROSYPHILIS
Veneral Disease Research Lab (VDRL)
test for detection of neurosyphilis (VDRL)
Latex Agglutination test- bacterial antigen
ELISA
FTA-Abs>VDRL>RPR (Rapid Plasma Reagin)
CONFIRMATORY test;to identify the causative agent in meningitis
csf culture
csf culture incubation period
Incubation:
24 hours = bacterial meningitis
6 weeks = tubercular meningitis
CENTRIFUGE GRAM STAINING AT
1,500G FOR 15 MIN
GRAM STAINING IN CSF DETECTS
Can detect:
* Streptococcus pneumoniae
* Haemophilus influenzae
* Escherichia coli
* Neisseria meningitidis
* Streptococcus agalactiae
* Listeria monocytogenes
Performed routinely on concentrated CSF to detect suspected CASES OF MENINGITIS
GRAM STAINING
Not routinely performed, unless TUBERCULAR MENINGITIS is suspected
ACID FAST STAINING AND FLUORESCENT ANTIBODY STAINING
For detection of Cryptococcus neoformans (fungal/cryptococcal
meningitis)
INDIA INK
parasite that is detected by india ink
cryptococcus neoformans
More sensitive; higher sensitivity than India ink
IMMUNOLOGIC ASSAY
Detect presence of CRYPTOTOCCUS NEOFORMANS ANTIGEN in serum
LATEX AGGLUTINATION TEST
Rapid test (reagent strip coated with monoclonal antibodies that react with cryptococcal polysaccharide capsule
Lateral Flow Assay (LFA)
Rapid test (rapid test kits)
ELISA
ELISA DETECTS:
Detects:
* Group B Streptococcus
* H.influenzae Type B
* S.pneumoniae
* N.meningitidis A,B,C,Y, and W135
* M.tuberculosis
* C.immitis
* E.coli KI antigens
SENSITIVE and SPECIFIC
Can detect the cause of meningitis with a small amount of pathogen’s DNA
Nucleic Acid Amplification Tests
