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CSF Flashcards

1
Q

A membranous three-layer coverings of brain and spinal cord.

A

Meninges

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2
Q

The third major body fluid.

A

CSF

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3
Q

Give three functions of CSF.

A
  1. Supply nutrients to the nervous system.
  2. Remove metabolic wastes.
  3. Produce a mechanical barrier to cushion the brain and spinal cord against trauma.
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4
Q

What are the three layers of meninges?

A

Dura Mater
Arachnoid Mater
Pia Mater

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5
Q

Tough mother, outermost layer

A

Dura Mater

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6
Q

Tender mother, innermost layer

A

Pia Mater

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7
Q

Spider-like, filamentous inner membrane

A

Arachnoid Mater

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8
Q

trabeculae are found in this space, which is filled with circulating CSF

A

subarachnoid space

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9
Q

where csf flows

A

subarachnoid space

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10
Q

composed of tight junctions of endothelial cells which makes up BBB

A

choroid plexus

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11
Q

What is the rate of production of choroid plexus?

A

20ml/hr
(500 ml/day; 0.3-0.4 ml/min)

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12
Q

prevents passage of many molecules

A

blood brain barrier

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13
Q

protects brain from toxins, infections, or other substances

A

blood brain barrier

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14
Q

it reabsorbs circulating CSF back to peripheral circulation

A

Arachnoid villi / granulations

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15
Q

What is the rate of reabsorption rate of arachnoid villi?

A

20 ml/hr

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16
Q

true / false

Rate of production = Rate of absorption

A

T

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17
Q

Two method of CSF collection.

A

Lumbar puncture / Spinal tap

Cisternal puncture

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18
Q

Puncture directly below occipital bone

A

Cisternal puncture

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19
Q

A procedure where needle is inserted into the lumbar subarachnoid space to collect cerebrospinal fluid (CSF) for laboratory testing,

A

Spinal tap / lumbar puncture

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20
Q

what are the vertebral location for spinal tap?

A

between the 3rd and 4th or the 4th and 5th lumbar vertebrae

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21
Q

How much CSF is collected in a patient?

A

20 ml

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22
Q

How many tubes are usually required for CSF collection?

A

Aseptically collected CSF fluid in 3 or 4 sterile tubes.

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23
Q

Which tube and section is stored at room temp?

A

Tube 2 - Micro

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24
Q

Which tube is for hema section? what temp?

A

Tube 3 - ref temp

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25
Q

4th tube for CSF collection is for ?

A

Optional
Micro - RT
Chem/Sero - Frozen

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26
Q

The first tube for CSF collection is for what section and temp?

A

Chem/ Sero - frozen

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27
Q

ONLY 1 tube of CSF was collected. What is our priority?

A

1) MICRO
2) hema
3) chem/sero

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28
Q

CSF volume of adults

A

90-150ml

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29
Q

Why is the 1st tube for chem/sero?

A

because chem/sero is least affected by blood or bacteria introduced during CSF collection

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30
Q

why is that the 2nd tube is for microbio?

A

bec it’s no longer at risk of bacteria/skin contamination due to csf collection

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31
Q

The 3rd tube is for HEMA section. Yes or No? and Why?

A

Yes, bec it least likely to contain skin cells after spinal tap.

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32
Q

CSF collection for neonates.

A

10-60ml

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33
Q

What is likely the cause of a hazy/turbid/milky/cloudy csf?

A

wbcs >200ul
rbcs >400ul
microorganisms
proteins
lipids

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34
Q

What is the most likely cause of a hazy/turbid/milky/cloudy csf?

A

wbcs >200ul
rbcs >400ul
microorganisms
proteins
lipids

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35
Q

What is the normal csf appearance?

A

Crystal clear

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36
Q

An abnormal discoloration of csf

A

Xanthochromia

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37
Q

a yellow csf appearance could be because of ?

A

1) degradation of oxyhgb to bilirubin
2) increased protein (>150mg/dl)
3) anti-septic contamination with iodine
xanthochromia

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38
Q

a pink csf appearance might be because of ?

A

the slight amt of oxyhgb

xanthochromia

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39
Q

an orange csf appearance might mean ?

A

1) Heavy hemolysis
2) hypervitaminosis A - presence of carotene

xanthochromia

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40
Q

an oily csf appearance

A

Radiographic contrast media

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41
Q

a csf is stored overnight inside ref, it formed an appearance of ?

A

pellicle - weblike

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42
Q

clinical significance of csf pellicle appearance

A

turbercular meningitis

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43
Q

a xanthochromia of csf giving red-orange color might be because of?

A

Rifampicin

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44
Q

a bloody csf appearance could mean that rbcs are?

A

Increased rbcs >6,000/ul

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45
Q

traumatic tap:

Distribution of blood
Clot formation
Supernatant
Erythrophages
D-dimer

A

Distribution of blood 1>2>3
Clot formation (+)
Supernatant - clear
Erythrophages (-)
D-dimer (-)

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46
Q

Intracranial Hemorrhage:

Distribution of blood
Clot formation
Supernatant
Erythrophages
D-dimer

A

Distribution of blood 1=2=3
Clot formation (-)
Supernatant - xanthochromic
Erythrophages (+); presence of hemosiderin and hematoidin crystals
D-dimer (+)

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47
Q

What are the clinical significance of a clotted CSF appearance?

A

Meningitis, FROIN SYNDROME (hypercoagulability xanthochromia, inc. protein), blockage of CSF circulation, traumatic tap

48
Q

any csf cell count must be performed later.

A

IMMEDIATELY

49
Q

What will happen to wbc and rbc within an hour after collection?

50
Q

What is the percentage of wbcs that will disintegrate within 2hrs

51
Q

t/f
rbcs are routinely performed on csf

52
Q

What is the diluting fluid for wbc count?

A

3% acetic acid with methylene blue

53
Q

T/F
3% acetic acid with methylene blue lyses wbc and stain.

54
Q

For every 700 rbcs, subtract 1 wbc. For every 10,000 rbcs/ul, subract 10mg/dl in total protein conc.

T/F

A

F, subtract 8 for every 10k

55
Q

Clinical significance of viscous csf.

A

Metastatic mucin-producing adenocarcinoma
Cryptococcal meningitis – polysaccharide (contributes to viscosity)
Liquid nucleus pulposus

56
Q

csf diff ct is done on stained csf smear, csf should be concentrated first before preparing smear.

T/F

57
Q

Clinical Significance: Ependymal, Choroidal, & Spindle-shaped cells

A

Diagnostic procedures - neurosurgery, pneumoencephalography

58
Q

Clinical significance: blast forms

A

Acute leukemia

59
Q

Clinical significance: macrophages

A

Intracranial hemorrhage

60
Q

Clinical significance: lymphoma cells

A

Disseminated lymphoma

61
Q

Clinical significance: plasma cells

A

Multiple sclerosis, lymphocyte reactions

62
Q

Clinical significance: neutrophils

A

Bacterial meningitis
Early case of viral, tubercular, & fungal meningitis
Cerebral hemorrhage

63
Q

What is Pleocytosis?

A

increased number of normal cells (mono, lympho) in CSF

64
Q

Normal ratio of lymphocytes and monocytes on csf of adults and newborns.

A

Adults = 70% L : 30% M
NB = 30% L : 70% M

65
Q

Clinical significance: malignant cells

A

Metastatic carcinoma, primary CNS carcinoma

66
Q

Major protein in CSF

67
Q

2nd most prevalents csf protein

A

Pre-albumin

68
Q

Clinical significance: monocytes and lymphocytes

A

Viral tubercular, fungal meningitis, Multiple sclerosis

69
Q

carbohydrate-deficient transferrin, ONLY present in CSF

70
Q

collect blood glucose 5hrs before spinal tap.

A

False. 2hrs before dapat.

71
Q

What is the preferred method for CSF TOTAL protein determination - turbidimetric?

A

TRICHLOROACETIC ACID (TCA) - 30% TCA

72
Q

Preferred method for CSF total protein determination, it precipitates both ____ & ______ .

A

TRICHLOROACETIC ACID (TCA) - 30% TCA, both albumin and
globulin

73
Q

What is the method for CSF TOTAL protein determination - turbidimetric that precipitates ONLY the ALBUMIN?

A

SULFOSALICYLIC ACID (SSA) - 3% SSA

74
Q

what should you add to precipitate globulins in 3% SSA?

A

Ppt globulins = add Na2SO4

75
Q

assesses conditions that results to IgG production within CSF
Ex. MS

76
Q

Detection of OLIGOCLONAL BANDS IN GAMMA REGION

A

CSF electrophoresis

77
Q

CSF total protein determination- dye binding: Protein binds to dye then dye turns from RED to BLUE

A

COOMASIE BRILLIANT BLUE

78
Q

Enumerate those with the presence of 2 oligoclonal bands in CSF but not in serum

A
  1. MS–persistent cause
  2. Neurosyphilis
  3. Encephalitis
  4. Neoplastic disorder
  5. Guillain-barresyndrome
79
Q

what could be the cause of an intense blue color in csf protein determination?

80
Q

What are the two CSF protein fractions determination?

A

1) CSF Albumin (mg/dL) / SERUM ALBUMIN (g/dL) INDEX
2) IGG INDEX

81
Q

A demyelinating disorder

82
Q

clinical significance of decreased csf glucose

A

Bacterial, tubercular, and fungal meningitis
Alterations in glucose transport across BBB
Increased used of glucose by brain cells

83
Q

Clinical significance of increased csf glucose?

84
Q

CSF glucose and lactate is normal in ?

A

Viral meningitis

85
Q

Clinical significance of increased csf lactate?

A

Bacterial meningitis (>35 mg/dL)
Tubercular & fungal meningitis (>25 mg/dl)
Hypoxia

86
Q

A waste product of glucose metabolism

87
Q

Indirect test for presence of excess NH3 in CSF

A

CSF glutamate

88
Q

Clinical significance of increased csf glutamate?

A

Disturbance of consciousness (>35 mg/dL)
Reye‟s Syndrome (75%)

89
Q

Increased NH3 = increased glutamate

T/F

90
Q

Normal pattern of CSF

91
Q

Isoenzymes in CSF

A

◦ LD1&2:braintx
◦ LD 2 & 3: lymphocytes ◦ LD 4 & 5: neutrophils

92
Q

what are csf enzymes?

A

LD, CK, AST

93
Q

Common Agents:
1. Group B streptococci
(neonates)
2. E. coli & other gram-negative bacilli (NB-1mos)
3. Neisseria meningitidis
(>3mos)
4. Streptococcus pneumonia
(>3mos)
5. Haemophilus influenza
(3mos-18yrs)
6. Listeria monocytogenes

A

Bacterial meningitis

94
Q

Agent: M. tuberculosis

A

Tubercular meningitis

95
Q

Both causes granulomatous amoebic encephalitis

A

Acanthamoeba spp.
Balamuthia mandrillaris

96
Q

Agent: C. neoformans

A

Fungal meningitis

97
Q

Common agents of amoebic meningoencephalitis

A
  1. Naegleria fowleri
  2. Acanthamoeba spp.
  3. Balamuthia mandrillaris
98
Q

primary agent of amoebic meningoencephalitis

A

Naegleria fowleri

99
Q

what are common agents of viral meningitis?

A

Enteroviruses
- Coxsackievirus
- Echovirus
- Poliovirus
Arbovirus

100
Q

Gold standard of viral meningitis

101
Q

Reagent of limulus lysate test?

A

Blood of horseshoe crab

102
Q

Detects gram negative (-) bacterial endotoxin body fluids & surgical instruments

A

Limulus lysate test

103
Q

Causative agents of spirochetal meningitis?

A

Neurosyphilis – T. pallidum
Neuroborreliosis – B. burgdorferi

104
Q

causative agent of neuroborreliosis?

A

B. burgdorferi

105
Q

What color will show when using acridine orange in a csf sample of a patient with amoebic meningoencephalitis?

106
Q

T/F
A csf sample positive for tubercular meningitis shows positive AFP stain and a pellicle formation after 12-24hrs of storage in ref.

107
Q

Diagnosis for spirochetal meningitis

A
  1. Nontreponemal tests (VDRL, FTA-Abs)
  2. ELISA
  3. Western Blot
108
Q

recommended by CDC to detect neurosyphilis

A

Nontreponemal tests - vdrl or fta-abs

109
Q

Viral meningitis:
WBC & Protein
Glucose & Lacatate

A

Increased wbc, protein
Normal glucose, lactate

110
Q

what pattern will show after (+) gram stain in a sample positive for fungal meningitis?

A

Starburst pattern

111
Q

◌ Fluid is added to a conical chamber
◌ Cells are forced into a monolayer within a 6mm
diameter circle on the slide
◌ Addition of 30% ALBUMIN:
• Increases yield or recovery
• Decreased cellular distortion

A

Cytocentrifugation

112
Q

Tubes for CSF fluid

A

CMHO

  1. Chem / Sero - frozen
  2. Micro - RT
  3. Hema - ref temp
  4. Optional - micro / chem/sero
113
Q

Tubes for SEROUS fluid

A

ESHP

  1. EDTA - cell/diff ct
  2. Sterile Heparin - micro
  3. Heparin - chem, other tests: sero
  4. Plain - clotting test
114
Q

Tubes for SYNOVIAL fluid

A

SALI NNA

  1. SPS / Sterile Na Heparin - micro
  2. LIQUID EDTA / Na Heparin - hema
  3. Non-anti-coagulated - chem/sero
  4. Na fluoride - glucose analysis
115
Q

• Increased: stroke, MS, degenerative disorders, brain
tumors, viral & bacterial meningitis, epileptic seizure

116
Q

• Increased: intracerebral and subaracnoid hemorrhage,
bacterial meningitis

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