Csf Flashcards
outermost membrane outermost membrane
dura matter
middle
* Pia mate
Arachnoid mater/Arachoidea “spider-web-like”
innermost layer and
adheres to the surface pf neural tissue.
- Pia mater “gentle mother”
Functionof csf
- Serves as a mechanical barrier against trauma
- Provides supply of nutrient to CNS tissue
- Remove metabolic wastes
CSF is produced via active transport secretion and filtration by the
____ of each of the four ventricles of the brain
choroid plexuses
Rate of production:
0.3 to 0.4 mL/min, ~ 20 mL/hr
volume adults
140 to 170 mL or 90 to 150 mL
neonates volume
10 to 60 mL
Used to represent the control and filtration of blood
components to the CSF and to the brain
Brain-Blood Barrier (BBB
In the choroid plexuses, the endothelial cells have a very tightfitting junctures that prevent the passage of many molecules.
These structures are termed as the
Brain-Blood Barrier (BBB)
- routine method for CSF collection, done
with fetal position or lateral decubitus position
lumbar puncture
sites of lumbar puncture inadults
Between 3rd and 4th (or lower) lumbar vertebrae
site of lumbar puncture in children
Between 4th and 5th lumbar vertebrae
puncture in sub-occipital region (cisterna magna)
Cisternal puncture
puncture for - infants with open fontanels
Ventricular puncture
order of collection: 1st tube test and storage?
Chemical and serological test; frozen at -15 to 30 deg cel
order of collection: 2nd tube
Microbiological test; room temp at 19 to 26deg cel
Order of collection; 3rd tube
cell count; refrigerated at 2 to 8 deg cel
tube 4
microbiology to chemistry or serology
order or collection; low volume csf
micro to hema to chem
order of collection; excess csf
mix together
stat basis
within 30 minutes
Appearance and color
clear and colorless
pH
7.4
Daily secretion
450-500mL
SG
1.006-1.007
Lymphocytes
1.5/HPF
Protein
15-45 mg/dL
Glucose
50-80 mg/dL
Chloride
115-130 mmol/L
Calcium
1.0-1.4 mmol/L
Phosphorus
0.4-0.7 mmol/L
Magnesium
1.2-1.5 mmol/L
Potassium
1.2-1.5 mmol/L
Clot formation but no blood
meningitis, Froin’s syndrome
Web-like/ pine tree clot, no blood
tubercular meningitis
Pellicle formation
suppurative meningitis
Clot formation + blood
traumatic tap
- Most frequently performed chemical test on CSF
Protein
Normal Values:
* 6 months to adults of protein
15 to 45 mg/dL
Normal Values:Newborns =Protein
75 to 150 mg/dL
Normal Values:>60 years oldProtein
> 60 mg/dL
proteins to be tested first to last
Albumin> Prealbumin> Haptoglobin and Ceruloplasmin>
transferrin
comparison between serum an CSF levels of
albumin and IgG must be made
- Protein Fraction
Normal Protein Fractions:
Albumin, Prealbumin, Alphaglobulins (Haptoglobin and Ceruloplasmin), Transferrin, TAU
protein, IgG, and IgA
Protein Fractions not normally found in CSF
IgM,
Fibrinogen, Beta-lipoproteins
Ammonium sulfate
Cloudy precipitate
Nonne-Apelt
Ammonium sulfate
White ring
Rose Jones
Phenol
Bluish white cloud
Randy’s
10% Butyric acid
Precipitate
Nogochi
Colloidal Gold
Solution
1+: Blue
2+: Purple
3+: Deep Blue
4+: Pale Blue
5+: Colorless
Colloidal Gold
Test
reagent of choice,
precipitates both albumin and globulins
Trichloroacetic acid (TCA):
precipitates albumin only
unless Na2SO4 is added
Sulfosalicylic acid (SSA):
Dye-Binding Techniques PRINCIPLE
: Protein Error of Indicators
Nephelometry test what
Benzalkonium chloride
Most frequently performedquantitative test
- Method of choice for the determination of CSF
Electrophoresis
- Detection of Oligoclonal Bands: Present in CSF but not in serum:
Multiple sclerosis,
Encephalitis, neurosyphilis, Guillain-Barre
syndrome, and Neoplastic disorders
Detection of Oligoclonal Bands: Present in both:
systemic and neurologic
involvement seen in leukemia, lymphoma, viral
infections
- Evaluates BBB integrity
CSF-Serum Albumin Index
index value for intact BBB
<9
index value for damaged BBB
> 9
Determines IgG production within the CNS
CSF-Serum IgG Index
index value of CNS serum IgG
> 0.77
normal values of glucose
60-70%
normal values of glucose in neonates
80%
Plasma sample should be collected ___prior to spinal tap
2 hours
glucose Should be tested immediately to prevent significant loss due
to
glycolysis
bacterial meningitis glucose
decreased glucose but inceased neutrophils
tubercular meningitis glucose
decreased but increased lymphocytes
Viral meningitis glucose
normal and increased lymphocytes
fungal meningitis glucose
normal ord decreased plus india ink for Candida neoformans
lactate function
- Aids in diagnosis and management of meningitis
- Used to evaluate effectiveness of antibiotic therapy
- Used to monitor severe head injuries
viral meningitis lactate value
<25 mg/dL:
tubercular and fungal meningitis lactate value
> 25 mg/dL:
bacterial meningitis lactate
> 35 mg/dL
Frequently performed in CSF but not in blood
Glutamine
Indirect measure of CSF ammoni
Glutamine
It is the metabolic product from the removal of ammonia
Glutamine
normal values of glutamine
8-18 mg/dL
clinical significance of glutamine
- Disturbance in consciousness (>35 mg/dL)
- Coma of unknown origin (result from increased usage of
alpha-ketoglutarate) - Reye’s syndrome (75% of diagnosed children)
Aids in the diagnosis of meningitis
Lactate Dehydrogenase Isoenzymes
LD: brain and tissue destruction
LD1 and LD2
