CSF Flashcards
3rd Major fluid of the body
CEREBROSPINAL FLUID
CEREBROSPINAL FLUID FUNCTION
Function:
o Supply nutrients to the nervous system
o Removes metabolic waste
o Produces a mechanical barrier to cushion the brain and the spinal cord
CSF produced in the?
choroid plexuses (third and
fourth ventricles)
3 layers of the meninges
Dura matter, Arachnoid, and Pia matter
called the hard matter, the outermost layer of the meninges
Dura matter
called the spider-web like
Arachnoid
known as the gentle
matter; near the spinal cord or brain
Pia matter
CSF flows through the _______________________ located between the arachnoid and pia matter
CSF flows through the subarachnoid space located between the arachnoid and pia matter
Tight fitting structures of endothelial cells in the choroid plexuses
BLOOD-BRAIN BARRIER
BLOOD-BRAIN BARRIER FUNCTION
Functions:
o To protect the brain from foreign
organism in the blood
o shields the brain from hormones and neurotransmitters the rest of the body
o Maintains homeostasis
region of the brain where the blood-brain barriers is weak
Circumventricular organ
List of Circumventricular organ
o Pineal gland
o Neurohypophysis – posterioir pituitary gland
o Area Postrema – vomiting center
o Subfornical organ
o Vascular organ of The Lamina terminalis
o Median Eminence
These are capillary networks that forms the CSF from the plasma by mechanism of selective filtration under Hydrostatic Pressure and Active Transport Selection
CHOROID PLEXUS
A pressure from across choroidal capillary wall and aids the filtration
HYDROSTATIC PRESSURE
Process by the choroidal epithelial cells that allows by the hydrostatic pressure to create CSF
ACTIVE TRANSPORT SELECTION
NORMAL VOLUME OF CSF:
* ADULTS =
* PEDIA =
NORMAL VOLUME OF CSF:
* ADULTS = 90 ML to 150 ML / 140 ML to 170 ML
* PEDIA = 10 ML to 60 ML
RATE OF PRODUCTION:
* ___/min
* ___/hour
* ___/ day
RATE OF PRODUCTION:
* 0.3 to 0.4 ML/min
* 20 ML/hour
* 500 ML/ day
SPECIFIC GRAVITY:
pH:
Osmolality:
SPECIFIC GRAVITY: 1.006 – 1.008
pH: 7.30 – 7.45
Osmolality: 281 mosmo/L
Specimen Collection of CSF
Collected by lumbar puncture via the:
o 3rd, 4th, 5th Lumbar Vertebrae (Lumbar region) and subdural tap
o Cisternal magna
o Ventricular region
Specimens are collected in three sterile tubes:
o Tube 1 =
o Tube 2 =
o Tube 3 =
o Tube 4 =
Specimens are collected in three sterile tubes:
o Tube 1 = chemical and serological test
o Tube 2 = microbiology →less
contamination of bacteria
o Tube 3 = cell count→ less contamination of the blood
o Tube 4 = Microbiology →chemistry/serology
Excess CSF should not be discarded and should be ______ until there is no further use for it
Excess CSF should not be discarded and should be frozen until there is no further use for it
Most important tube?
Microbiology
2nd priority tube?
cell count or hematology
Last priority tube?
chemical and serological test
If STAT is not possible, CSF specimen should be maintained:
* Hematology spx =
* Microbiology spx =
* Chemistry and Sero spx =
If STAT is not possible, CSF specimen should be maintained:
* Hematology spx = refrigerated (2 8oC)
* Microbiology spx = room temperature (19-26oC)
* Chemistry and Sero spx = Frozen (-15 to -30oC)
CSF INTRACRANIAL PRESSURE
- Infant:
- Adult:
CSF INTRACRANIAL PRESSURE
- Infant: 10-100 mm of water
- Adult: 90-180 mm of water
Cause of Increase Pressure in CSF Intracranial
- Intracranial hypertension
- Hemorrhage
- Meningitis
- Subarachnoid bleeding
- Brain tumor or brain abscesses
Cause of Decrease Pressure in CSF Intracranial
- Spinal subarachnoid block
Test for Spinal subarachnoid block
Queckenstedt Test
CSF APPEARANCE
- Normal:
- Turbid or Milky:
CSF APPEARANCE
- Normal: crystal clear
- Turbid or Milky: increased protein or lipid concentration; also indicate infection.
CSF Components:
CSF Components:
o Proteins
o Glucose – 2/3 of blood glucose
o Chloride – 1/3 of plasma fluoride
o Sodium chloride
o Magnesium
o Potassium
o Calcium
Term to describe CSF supernatant depends on its color
XANTOCHROMIA
CSF supernatant:
o Pink –
o Orange –
o Yellow –
CSF supernatant:
o Pink – very light amount of
oxyhemoglobin
o Orange – heavy hemolysis
o Yellow – conversion of oxyhemoglobin to unconjugated bilirubin
Factors that cause Xantochromia:
Factors that cause Xantochromia:
o RBC degradation product → pink
o Elevated bilirubin → yellow
o Presence of carotene pigment → orange
o Markedly increased protein concentration
o Melanoma pigment
A grossly bloody CSF sample due to the puncture of a blood vessel during the spinal tap procedure
TRAUMATIC TAP
Clot Formation:
o Clot formation + blood →
o Clot formation but no blood→
o Web-like/pine tree clot, no blood →
o Pellicle formation →
Clot Formation:
o Clot formation + blood → traumatic tap
o Clot formation but no blood→ meningitis, Froin’s syndrome
o Web-like/pine tree clot, no blood → tubercular meningitis
o Pellicle formation → suppurative
meningitis
Term use for small fine clots that may be seen in the surface of the CSF after 12 – 24 hours of the refrigeration, which consist of white blood against fibrinous background
Pellicles
A Xantochromic Supernatant would be the result of blood that has been present in the CSF sample for________________________.
A Xantochromic Supernatant would be the result of blood that has been present in the CSF sample for more than 2 hours.
NORMAL CELL COUNT:
ADULT =
INFANT =
NORMAL CELL COUNT:
ADULT = 0 to 5 WBCs/ul
INFANT = 30 WBCs/ul
Routinely used chamber in cell count
Improved Neubauer Counting Chamber
____________________ is used to lyse the RBCs addition of ______________ to the diluting fluid stains that WBCs, providing better differentiation between neutrophils and mononuclear cells.
3% Glacial Acetic Acid is used to lyse the RBCs addition of Methylene Blue to the diluting fluid stains that WBCs, providing better differentiation between neutrophils and mononuclear cells.
All diluents should be checked for
contamination by examination in a counting chamber under __ magnification _____ a week
All diluents should be checked for
contamination by examination in a counting chamber under 4X magnification twice a week
If non-disposable counting chamber are used. They must be soaked in a bactericidal solution for ______________ and thoroughly rinse with water and cleaned with ___________________
If non-disposable counting chamber are used. They must be soaked in a bactericidal solution for 15 minutes and thoroughly rinse with water and cleaned with isopropyl alcohol
Time employed in centrifugation for differential count
5-10 minutes
Lymphocytes and monocytes ratio for adults
70:30
Lymphocytes and monocytes ratio for children
30:70
______ are seen as a result of bone marrow contamination during spinal tap
NBRCs are seen as a result of bone marrow contamination during spinal tap
Increased normal, reactive lymphocytes and plasma cells may indicate ________________
Increased normal, reactive lymphocytes and plasma cells may indicate multiple sclerosis
Macrophage hours take to appear after RBCs enters the CSF
2-4 hours
Increased of macrophage indicates
previous hemorrhage
They are iron-free consisting the
hemoglobin and unconjugated
bilirubin
Yellow hematoidin crystals
Normal values of CSF chemicals are ______________ as the plasma values
Normal values of CSF chemicals are not the same as the plasma values
Frequently performed chemical test on CSF
Protein determination
Normal CSF Protein
15 to 45 mg/dL
It makes up the majority of CSF
protein, followed by pre albumin
Albumin
It is a separate carbohydrate deficient transferrin fraction that only seen in the CSF
Tau protein
Presence of TWO or MORE oligoconal bands that are not present in the serum can be
valuable tool for diagnosis of __________________
Presence of TWO or MORE oligoconal bands that are not present in the serum can be
valuable tool for diagnosis of multiple sclerosis
