CSF Flashcards
how much csf do adults produce
20 mL per hour
where is the CSF produced
choroid plexuses of the two lumbar ventricles 3rd and 4th ventricles
where does the csf flow
subarachnoid space
where is the subarachnoid located
between arachnoid and pia matter
volume of csf in adults
90-150ml
volume of csf in neonates
10-60ml
how do the bodies maintain the fluid?
circulating fluid is reabsorbed back into the blood capillaries
where is the fluid being reabsorbed
arachnoid granulations/ villae
are capillary networks that form the CSF from plasma by mechanism of selective filtration under hydrostatic pressure and transport secretion
choroid plexuses
tight fitting structure of the endothelial cells in the choroid plexuses is termed
blood brain barrier
what is the procedure for obtaining CSF
lumbar puncture
what is the contraindication of this procedure
presence of infection at the pucnture site
how much volume of csf do we need for testing?
10-20ml
state the tubes for testing
chemistry serology
microbiology
hematology
additional tests
if the sample is only enough for one tube what must be tested first?
microbiology
tests are least affected by blood or bacteria introduced as a result of the tap procedure
chemical and serologic test
mode of preservation for chemical and serologic test
freezing
mode of preservation of sample for microbiology
room temperature
least likely to contain cells introduced by the spinal tap procedure
cell count
mode of preservation of the specimen for cell count
refrigerated
provides better exclusion of skin contamination
microbiology and additional serologic test
appearance of the csf specimen is normal (interpret)
crystal clear
csf appearance is hazy, turbid, milky, cloudy what are the possible causes?
wbcs
microorganism
protein
clinical significance of the csf specimen that is appeared to be hazy, turbid, milky, cloudy
meningitis
disorders that affect blood brain barrier
production of IgG within the CNS
csf specimen appearance is bloody what are the causes?
rbc
clinical significance of csf specimen that appears to be bloody
hemorrhage
traumatic tap
csf specimen appears to be clotted what are the causes?
protein
clotting factors
clinical signficance of csf appeared to be clotted
disorders affecting blood brain barrier
introduced by traumatic tap
appearance of csf appears to be xanthochromic what are the causes?
hemoglobin
bilirubin
carotene
protein
melanin
clinical significance of xanthochromic appearance
old hemorrhage
lysed cells from traumatic tap
(rbc degredation, elevated serum bilirubin levels)
disorders affecting blood brain barrier
meningeal menalosarcoma
csf specimen appears to be pellicle what are the causes?
protein
clotting factors
clinical significance of pellicle appearance of csf sample
disorders that affect the blood brain barrier
tubercular meningitis
bloody csf can be a indication of
intracranial haemorrhage
puncture of blood vessel during spinal tap (traumatic tap)
what is the distribution of blood under traumatic tap
uneven
1st container greatest
3rd tube no blood
what is the distribution of blood under intercranial hemorrhage
even distribution
clot formation under traumatic tap
introduction of fibrinogen
clot formation under intracranial hemorrhage
not enough fibrinogen to clot
xanthochromic supernatant under traumatic tap
clear supernatant
xanthochromic supernatant under intercranial hemorrhage
rbcs stay in the csf for 2 hours
rbcs stays for 2 hours in the csf under xanthochromic supernatant what is the back up test?
d-dimer test
microscopic finding of erythrophagocytosis
all diluents should be checked biweekly for contamination (true or false)
true
the speed of the centrifuge should be checked monthly with a tachometer (true or false)
false (cytocentrifuge)
if non disposable counting chambers are used they must be soaked in a?
bactericidal solution
how many minutes do we have to soak the counting chambers?
15 minutes
cell count of csf must be performed immediately (true or false)
true
How many are wbcs in a csf
0-5 / uL
number of wbcs or rbcs that may appear clear
200 wbc
400 rbc
what is the standard calculation used for csf cell count
neubauer calculation
wbc count dilution used
3% glacial hac
purpose of 3% glacial hac
lyses rbc
what stain is used added to the diluting fluid for wbc count
methylene blue
this stain differentiates neutrophils and mononuclear cells
methylene blue
what stain is used for differential count
wright stain
specimen should be concentrated prior to the preparation of the smear. what are the procedures recommended?
sedimentation
filtration
centrifugation
cytocentrifugation
routine procedure used for differential count
cytocentrifugation
how many minutes do we have to cytocentrifuge the specimen?
5-10 minutes
manner of reporting for differential count
report in percentage
if <100 cells are counted how do we report it?
report only the number of the cell types seen
lymphocytes clinical significance
normal
viral
tubercular
fungal
mengitis
multiple sclerosis
neutrophils clinical significance
bacterial meningitis
early cases of: viral, tubercular, fungal meningitis
cerebral hemorrhage
microscopic finding of neutrophils
granules may be less prominent than in blood
cells disintegrate rapidly
monocytes clinical significance
normal
viral
tubercular
fungal meningitis
multiple sclerosis
microscopic finding of monocytes
found mixed with lymphocytes
macrophages clinical significance
rbcs in the spinal fluid
contrast media
may contain phagocytized rbcs appearing as empty vacuoles or ghost cells, hemosiderin granules and hematoidin crystals
macrophages
blast forms clinical significance
acute leukemia
microscopic findings of blast form
lymphoblasts
myeloblast
monoblast
plasma cells clinical significance
multiple sclerosis
lymphocyte reactions
microscopic findings of plasma cells
traditional and classic forms seen
what are the non pathologically significant cells
choroidal cells
ependymal cells
spindle shaped cells
what are the malignant cells
lymphoblast
myeloblast
monoblast
lymphoma cells
non hematological cells
astrocytoma
retinoblastoma
medulloblastoma
these cells are form the epithelial lining of the choroid plexus
choroidal cells
these cells are seen singularly and in clumps
choroidal cells
nucleoli is usually____ and have a _____ appreance
absent
uniform
these cells are form the lining of the ventricles and neural canal
ependymal cells
these cells have less defined cell membranes and are frequently seen in clusters
ependymal cells
in ependymal cells the nucleoli are often____
present
these cells represent the lining cells from the arachnoid
spindle shaped cells
they are usually seen in clusters and may be seen with systemic malignancies
spindle shaped cells
normal value of csf protein in adults
15-45 mg/dl
normal value of csf protein in infants
150 mg/dl
normal value of csf proteins in immature
500 mg/dl
csf proteins are increased by?
- damage to blood brain barrier:
meningitis
hemorrhage - production of Igs in CNS:
multiple sclerosis
csf proteins are decreased in
csf leakage
what is the major csf protein
albumin
2nd major csf protein
prealbumin
what are the a-globulins
haptoglobulin
ceruloplasmin
what are the b-globulin
b - transferrin
what are the y-globulins
IgG
IgA
what are the immunoglobulins that are not found in the csf
IgM
fibrinogen
lipids
carbohydrates are found in csf but not in serum (true or false)
true
2nd most prevalent faction in csf protein
prealbumin
protein that is unique to the csf (carbohydrate deficient transferrin)
tau protein
what chemistry test is used for detecting;
damage to blood brain barrier
prod of ig within the CNS
decreased clearance of normal protein
degeneration of neural tissue
CSF protein
what chemistry test is used for determining causative agents in meningitis
increased neutrophils
increased lymphocytes
glucose
blood glucose is drawn ____ prior to the spinal tap
2 hours
normal value of glucose in csf
60%-70%
decrease of glucose
increased neutrophils
bacterial
decrease of glucose
increased lymphocyte
tubercular
no. of glucose + increased lymphocyte
viral
what are the tests for csf total protein determination
turbidimetric
nephelometry
dye binding
if CHON binds to dye what color is the product
red to blue
increased blue color in dye binding indicates what?
increased protein
what are the tests for protein fractions in csf determination
csf/serum albumin index
IgG indexc
less than___ represents an intact blood brain barrier
9
index of ____ indicates complete blood brain barrier
100
this test is correlated to degree of damage
csf/serum albumin index
this test is for the assessment of conditions with IgG production within the CNS
IgG Index
_____ indicative of IgG production within the CNS
0.70
this test is for detection of oligoclonal bands in the g-region
electrophoresis
oligoconal bands in the g region is an indicative of?
IgG production
presence of 2 or more oligoclonal bands in the CSF but not with serum is valuable for diagnosis of?
multiple sclerosis
protein component of lipid-protein complex that insulates the nerve fibers
myelin basic protein
presence of myelin basic protein indicates?
destruction of myelin sheaths
values of lactate in bacterial, tubercular, fungal meningitis
> 25 mg/dl
value of lactate in bacterial
> 35 mg/dl
value of lactate in viral meningitis
<25 mg/dl
destruction of tissue within the CNS owing to oxygen deprivation
hypoxia
hypoxia causes the production of
increased CSF lactic acid levels
this test is for diagnosing and management of meningitis cases
lactate test
this test is used to monitor severe head injuries
lactate test
normal value of glutamine
8-18 mg/dl
this test is frequently requested for px with coma of unknown origin
glutamine
value of glutamine for px with coma of unknown origin
> 35 mg/dl
provides an indirect test for the presence of excess ammonia in the csf
glutamine test
test for fungal meningitis
india ink preparation
gram stain
appearance of C. neoformans in gram stain
starburst pattern
24 hours of culture
for bacterial
6 weeks of culture
for tubercular
common causative agent bacterial meningitis (birth to 1 month)
S. agalactiae
1 month to 5 y/o bacterial menigitis causative agent
H. influenza
5-29 yrs old bacterial menigitis causative agent
N. meningitides
> 29 years old
S. pneumonia
infants, elderly, immunocompromised
L. monocytogenes
can provide a rapid method for detecting C. neoformans
lateral flow assay
test for syphilis.
Fluorescent treponemal antibody absorption
rapid plasma regain (RPR) test is not recommended because it is less sensitive than the VDRL (true or false)
true
Venereal Disease Research Laboratories (VDRL)-
neurosyphilis
