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Clinical Pathology - Neurosciences > CSF in Disease Diagnosis > Flashcards

CSF in Disease Diagnosis Flashcards

1
Q

What is the total volume of cerebrospinal fluid (CSF) in adults?

A

Total volume in adults ≈135-150ml.

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2
Q

Where is CSF produced?

A

CSF is produced by the choroid plexuses in the lateral ventricles.

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3
Q

How does CSF flow through the brain and spinal cord?

A

CSF flows through the third and fourth ventricles into the sub-arachnoid space and surrounds the brain and spinal cord.

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4
Q

How is CSF reabsorbed into the circulation?

A

CSF is reabsorbed into the circulation by arachnoid villi.

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5
Q

What are the functions of CSF?

A

Functions of CSF include buoyancy, protection, chemical stability, and prevention of brain ischemia.

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6
Q

What is the actual brain mass and the weight of the brain suspended in CSF?

A

The actual brain mass is 1400g, and the weight suspended in CSF is 25g.

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7
Q

What conditions can CSF analysis help diagnose?

A

CSF analysis can help diagnose meningitis, encephalitis, CNS or metastatic tumors, syphilis, bleeding in the brain and spinal cord, Guillain-Barre syndrome, unexplained seizures, and infected skin at the lumbar puncture site.

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8
Q

What are the contraindications for lumbar puncture?

A

Contraindications for lumbar puncture include severe pulmonary or lumbar disorders, focal neurologic deficits, and immunocompromised states.

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9
Q

What are some possible complications of a lumbar puncture?

A

Possible complications of a lumbar puncture include post-tap headache, vomiting, epidural hematomas, subdural or subarachnoid hemorrhage, acute neurologic or respiratory deterioration, cerebral herniation, and infection or abscess formation.

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10
Q

Describe the procedure for CSF collection and transport.

A

CSF collection and transport should be performed aseptically by an experienced medical officer, and the sample should be transported immediately to the lab.

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11
Q

What preparation is necessary before performing a lumbar puncture?

A

Before performing a lumbar puncture, rule out contraindications, perform a CT scan if necessary, and inform the laboratory staff.

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12
Q

What is the correct patient position for a lumbar puncture?

A

The patient should be positioned on their left side with their back on the edge of the bed and fully flexed (knee to chin) or in a sitting position for patients with pulmonary disorders or young infants.

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13
Q

What is the landmark for needle insertion during a lumbar puncture?

A

The landmark for needle insertion is the plane of the iliac crest through the L4-L5 intervertebral space.

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14
Q

What are the steps for sterilizing the site for a lumbar puncture?

A

Sterilize the site with tincture of iodine or methylated spirit in a circular outward motion.

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15
Q

What type of bottles are used for CSF collection and what should they contain?

A

CSF collection bottles should include a sterile bottle, lithium heparin, EDTA bottle, and a fluoride oxalate bottle.

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16
Q

What is the correct needle size for a lumbar puncture?

A

A 22G spinal needle with a stilette is used for a lumbar puncture.

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17
Q

How is the CSF pressure measured during a lumbar puncture?

A

CSF pressure is measured with a manometer (90-180 mmH2O).

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18
Q

What should be done after collecting the CSF sample?

A

After collecting the CSF sample, send it promptly for analysis, lie the patient flat for 15-30 minutes, check CNS observations and BP, and ask about headaches.

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19
Q

Describe the appearance of normal CSF.

A

Normal CSF is clear and colorless.

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20
Q

What does red or bloody CSF indicate?

A

Red or bloody CSF indicates a traumatic tap or subarachnoid hemorrhage (SAH).

21
Q

What does turbid or cloudy CSF suggest?

A

Turbid or cloudy CSF suggests acute pyogenic meningitis.

22
Q

What is xanthochromia and what can it indicate?

A

Xanthochromia is a pink/orange/yellow colored CSF and can indicate RBC lysis, SAH, ICH, or increased bilirubin levels.

23
Q

What does the presence of a coagulum or viscous CSF indicate?

A

A coagulum or viscous CSF indicates high protein content, often seen in TB meningitis or CNS tumors.

24
Q

What is the normal glucose level in CSF?

A

Normal glucose level in CSF is approximately 2/3 of fasting plasma glucose.

25
Q

What glucose level in CSF is often associated with bacterial and fungal meningitis?

A

A glucose level below 40mg/dl in CSF is often associated with bacterial and fungal meningitis and malignancy.

26
Q

What are some causes of high protein levels in CSF?

A

High protein levels in CSF are seen in bacterial and fungal meningitis, tuberculosis, tumors, subarachnoid hemorrhage, traumatic tap, abscess, and multiple sclerosis.

27
Q

How is glucose estimation in CSF performed in the lab?

A

Glucose estimation in CSF is performed using the oxidase or hexokinase method.

28
Q

How is protein estimation in CSF performed in the lab?

A

Protein estimation in CSF is performed using the sulpho salicylic acid or triacetic acid method, or by electrophoresis for suspected monoclonal gamopathy.

29
Q

What does an increased level of lactate in CSF indicate?

A

Increased lactate in CSF indicates bacterial and fungal meningitis.

30
Q

What conditions are associated with elevated lactate dehydrogenase in CSF?

A

Elevated lactate dehydrogenase in CSF is associated with bacterial and fungal meningitis, malignancy, and subarachnoid hemorrhage.

31
Q

What initial test is done when CSF is cloudy?

A

The initial test for cloudy CSF is a Gram smear.

32
Q

How should a Gram smear be prepared and stained?

A

A Gram smear should be prepared by centrifuging the sample, transferring the sediment to a slide, air drying, alcohol-fixing, and staining with Gram technique.

33
Q

What type of bacteria can be identified using a Gram smear?

A

Gram smears can identify G -ve intracellular diplococci (N. meningitidis), G +ve diplococci (S. pneumoniae), G -ve rods (H. influenzae, E. coli), and yeast cells (C. neoformans).

34
Q

What is the significance of finding yeast cells in a Gram smear?

A

The presence of yeast cells in a Gram smear indicates cryptococcal meningitis.

35
Q

How should CSF be cultured?

A

CSF should be cultured ASAP on chocolate agar, blood agar, and MacConkey agar, and incubated accordingly.

36
Q

What conditions make a CSF sample unsuitable for cell count?

A

Heavily blood-stained or clotting CSF samples are unsuitable for cell count.

37
Q

What stains are recommended for diluting CSF during cell count?

A

Isotonic 1% toluidine blue or isotonic methylene blue stains are recommended for diluting CSF during cell count.

38
Q

How is a CSF cell count performed using a counting chamber?

A

CSF cell count is performed using a modified Fuchs-Rosenthal ruled counting chamber and a microscope.

39
Q

What is the purpose of Ziehl-Neelsen staining in CSF analysis?

A

Ziehl-Neelsen staining is used when TB meningitis is suspected.

40
Q

What are the steps for preparing a Ziehl-Neelsen smear?

A

Ziehl-Neelsen smear preparation involves centrifuging CSF, transferring sediment to a slide, fixing with methanol, and staining with ZN stain.

41
Q

How is cryptococcal meningitis suspected and confirmed using CSF?

A

Cryptococcal meningitis is suspected with yeast cells on Gram smear and confirmed with India ink preparation.

42
Q

What culture media are used for growing different bacteria from CSF?

A

Chocolate and Blood agar cultures can identify N. meningitidis, S. pneumoniae, and H. influenzae.

43
Q

What are the typical appearance and lab findings for normal CSF?

A

Normal CSF is clear and colorless with <5x10^6/L lymphocytes, 0.15-0.4 g/L protein, and 2.5-4.0 mmol/L glucose.

44
Q

What are the typical appearance and lab findings for pyogenic bacterial meningitis?

A

Pyogenic bacterial meningitis CSF is purulent/cloudy with many pus cells, high protein, and very low glucose.

45
Q

What are the typical appearance and lab findings for viral meningitis?

A

Viral meningitis CSF is clear or slightly turbid with increased lymphocytes, normal or increased protein, and usually normal glucose.

46
Q

What are the typical appearance and lab findings for tuberculosis meningitis?

A

Tuberculosis meningitis CSF is clear or slightly turbid with increased lymphocytes, high protein, and reduced glucose.

47
Q

What are the typical appearance and lab findings for cryptococcal meningitis?

A

Cryptococcal meningitis CSF is clear or slightly turbid with increased lymphocytes, high protein, and reduced glucose.

48
Q

What causes hydrocephalus and what are its symptoms?

A

Hydrocephalus is caused by blockage of CSF flow, leading to symptoms like an enlarged head in infants and sun-setting eyes.

49
Q

How is hydrocephalus treated?

A

It is treated by addressing the primary cause and through the use of shunts for intermittent relief.

Clinical Pathology - Neurosciences (1 decks)

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