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Spinal Surgery 1 > CSF Sampling and Analysis > Flashcards

CSF Sampling and Analysis Flashcards

1
Q

What can be used to assess protein levels in CSF?

A

Urine dipstick

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2
Q

What restraint is needed for CSF collection?

A

General anaesthetic

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3
Q

Where to take a CSF sample?

A

The site from which the CSF is to be taken depends on the neuroanatomical localisation. As a general rule, collection should be performed from a site caudal to, or anatomically close to, the suspected lesion.

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4
Q

For the investigation of intracranial or cervical pathology; sample should be taken from?

A

cisterna magna (cerebellomedullary cistern, CM)

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5
Q

In lesions caudal to T3 where is CSF taken?

A

Lumbar collection

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6
Q

In cases of multifocal localisation, where is CSF collected?

A

Both sites

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7
Q

T or F
In dogs with thoracolumbar myelopathy, CSF collected from the CM cistern may not be representative of the underlying disease process.

A

True

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8
Q

What position should the patient be for CSF?

A

Lateral recumbency

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9
Q

What parameters need to be carefully monitor with a CSF?

A

Cardioresp

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10
Q

Why check the ET tube with CSF?

A

Check it does kink when neck flexed

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11
Q

Does the ET tube often need to be cuffed or uncuffed?

A

Uncuffed

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12
Q

What collection site is associated with a lower risk of blood contamination and often provides a larger volume of fluid for evaluation?

A

Cisterna magna

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13
Q

CSF collection usually follows advanced imaging in cases of intracranial pathology and should only be performed if there are no signs of?

A

Increaed ICP

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14
Q

When collected prior to the myelography, what should you do with the fluid why?

A

evaluated prior to injection of contrast, especially in cases where inflammatory disease is highly suspected.

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15
Q

When is CSF sampling contra indicated?

A

Signs or suspicion of a coagulopathy (e.g., thrombocytopaenia, Von Willebrand disease).

Signs suggestive of raised intracranial pressure either clinically (e.g., head pressing, anisocoria, reduced oculocephalic reflex) or on advance imaging.

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16
Q

Which breed would CSF sampling of the CM be contra indicated/or at least imaging taken first?

A

CKCS
French bulldog
Griffon Bruxellois

  • Where chiari like malformation is common
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17
Q

CSF has low protein levels; what is the result of this on leukocytes?

A

Rapid deterioration

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18
Q

Within what time frame should a CSF sample be processed?

A

30-60 mins

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19
Q

How much fluid should be collected for CSF?

A

0.5ml should be enough; more will be needed if PCR etc

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20
Q

CSF Macroscopic evaluation. What is normal?

A

Clear

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21
Q

Why might CSF fluid be pink - red?

A

haemorrhage (either due to pathology or iatrogenic contamination)

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22
Q

Why might CSF be yellow xantochromic?

A

Old haemorrhage (>48 hours).

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23
Q

Why might CSF be yellow-green? (2)

A

secondary to purulent inflammation or neoplasia,

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24
Q

Why might CSF be grey-black?

A

melanin granules or melanocytes are present.

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25
Q

What does normal protein levels of CSF depend on? (3)

A

Species
Site
Method of measuring

26
Q

Is protein higher in cisterna magna or lumbar collection? Why?

A

The protein level is generally higher if collection is performed from the lumbar site due to the cranial to caudal flow of CSF.

27
Q

How to know if protein is elevated on urine dipstick?

A

++ or more, the CSF protein level is likely to be elevated (assuming the CSF is not blood contaminated).

28
Q

If urine dip for protein is negative or trace; what dos this mean?

A

CSF likely normal

29
Q

If CSF protein is + on urine dip; what does this mean?

A

ivocal and required quantification.

30
Q

What tube to send CSF in to lab to quantify protein?

A

Plain

31
Q

Normal CSF:
A) Erythrocytes?
B) WBC?

A

A) None
<5uL

32
Q

What is an increased erthrocyte in CSF usually due to?

A

Contamination

33
Q

Define pleocytosis

A

Increased WBC

34
Q

How can CSF total cell count be performed manually?

A

counting chamber (eg., Malassez, Neubauer, or Fuchs Rosenthal)

35
Q

To perform manural cell count of CSF; do you:
A) Stain?
B) Centrifuge?

A

A) No
B) No

36
Q

Cytocentrifugation is often required to obtain a differential cell count and to..? Why is it done this way?

A

evaluate cell morphology in view of the usual low cellularity of the CSF,

37
Q

What is used to centrifuge CSF?

A

Cytospin

38
Q

Blood contamination may falsely increase(2)

A

protein level and cell count.

39
Q

Define mild RBC contamination

A

(< 5000 RBC/uL).

40
Q

If there is mild RBC contamination; how can you interpret the protein with a formula?

A

For every 1000 RBC, adjust protein down 1mg/dL.

41
Q

If there is mild RBC contamination; how can you interpret the leukocytewith a formula?

A

For every 500 RBC, leucocyte count can be adjusted down by 1 WBC/uL.

42
Q

An increased protein level with normal total cell count is called?

A

albumin-cytological dissociation

43
Q

albumin-cytological dissociation; what can this be due to physiologically? (3)

A

An altered blood brain barrier (BBB) which allow protein from the blood circulation to enter the CNS
Increased production within the CNS,
Obstruction of flow

44
Q

albumin-cytological dissociation; This is a non-specific finding and as such can be seen in. What are the possible underlying causes? (4)

A

compressive lesions,
neoplasia,
ischaemic Myelopathy
degenerative myelopathy amongst others.

45
Q

eosinophilic pleocytosis is usually associated with what prognosis?

A

Poor

46
Q

What count is extremely important in determining the most likely differential diagnoses, treatment, and in some cases prognosis ?

A

Differential cell count

47
Q

Lymphocytis pleocytosis:
A) Protein level?
B) WBC level?
C) % lymphocytes?

A

A) Increased
B) >5 u/L
C) >50%

48
Q

What can cause lymphocytic pleocytosis? (2, amongst others)

A

lymphoma,
Necrotizing non-suppurative meningoencephalitis

amongst others.

49
Q

Mixed cell pleocytosis:
A) Protein level?
B) WBC level?
C) cells seen?

A

A) Increased
B) >5 uL
C) Mix of lymphocytes and mononuclear cells

50
Q

What can cause mixed cell pleocytosis? (3, amongst others)

A

GME
Fungal
Protozoal dx

Amongst others

51
Q

Neutrophillic pleocytosis:
A) Protein level?
B) WBC level?
C) What cells?

A

A) Increased
B) >5 uL
C) Neutrophils predominant

52
Q

What can cause neutrophillic pleocytosis? (3)

A

Steroid responsive meningitis arteritis
Bacterial meningitis
Following myelography

53
Q

Eosinophilic pleocytosis:
A) Protein level?
B) WBC level?
C) What cells?

A

A) Increased
B) >5 uL
C) eosinophils predominant

54
Q

What can cause eosinophillic pleocytosis? (2)

A

Parasitic
Idiopathic

55
Q

What cellular inclusions may be seen in CSF? (3)

A

lysosomal storage diseases
canine distemper virus inclusions;
abnormal lymphocytes in cases of lymphoma

56
Q

What larvae may be seen in CSF?

A

Angiostrongylus spp.

57
Q

What micro-organism may be seen in CSF?

A

Cryptococcus neoformans

58
Q

CSF PCR can be performed in cases where an infectious aetiology is suspected.

What might be looked for in dogs? (3)

A

Canine distemper
Neospora
Toxoplasma

59
Q

CSF PCR can be performed in cases where an infectious aetiology is suspected.

What might be looked for in cats? (2)

A

Toxoplasma
Coronavirus

60
Q

Why is it important to run PCR on CSF?

A

In some cases, blood serology can be negative

61
Q

If the history is consistent, culture of CSF can be performed, however, it is negative in more than ?% of the case

A

60%

62
Q

What volume of CSF is needed for culture?

A

LARGE!

Spinal Surgery 1 (10 decks)

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