Intro CSF Flashcards
where is CSF fluid found
in subarachnoid space between pia mater and dura mater
what are the spinal meninges
pia mater, arachnoid mater, and dura mater
where is spinal fluid produced
choroid plexus
blood brain barrier purpose
bidirectional siv between blood and spinal fluid
-keeps SF sterile
how much SF is produced is produced every hour in an adult
20 mL
at any given time how much SF does an adult have
90-150 mL
at any give time how much SF does a child have
10-60 mL
function of SF
-brings nutrients to cord and nerve tissue and remove waste products
-serves as cushion to protein brain and spinal cord
only time looking for SF
spinal tap
lumbar puncture
reasons for looking for SF
- sus meningitis
- diagnosis demyelinating disease
- diagnosis subarachnoid hemorrhage
- malignancy or cancerous growth diagnosis
how to get SF?
-between L3 and L4 or L4 and L5
-xray to see
-fetal position opens up vertebrae
-lay flat for 30 min to an hour
-draw in tubes 1-4
tube 1 goes to
chem and serology
tube 2 goes to
micro
if multiple tubes give to micro
tube 2 will be cleaner
NO refrigerate!! kill of pathogens
STAT
tube 3 and 4 goes to
heme
-blood will be in other tubes not this one if a traumatic tap
if only can get 1 tube
MICRO- less risk of contamination
if any SF left over
keep for 6 months frozen
before and after taking SF need to measure
cranial pressure
how to measure pressure of SF
manometer and needle
once drawn should be 90-180 mL mercury
how much SF to remove for a norm adult
20 mL
if rapid decrease STOP
once done pressure should not drop more between
10-30 mg
if pressure is above or below certain values
> 200 or <90 make decision and only take 2 mL
appearance of SF
clear
1st thing done when get SF
macro description
always note TURBIDITY- seen in meningitis
blood?
traumatic tap in tubes looks like
blood decreases as # of tubes increase
1 reason for seeing RBC in SF
traumatic tap
what does hemorrhage look like in tubes
of RBC evenly distributed in all tubes
-no clotting
what does xanthochromic mean
slightly yellow or pinkish
what can cause xanthochromic SF
bilirubin
-seen in neonates because immature liver and nRBCs
what no xanthochromic/bili in traumatic tap
not sitting around long enough
what does micro look for
meningitis
always cytocentrifuge
anything in SF can cause meningitis
neisseria meningitis
1 cause of mening.
gram - diplo cocci
haemophilus influenze
2 cause
gram - rods
beta strep group B
gram + cocci
strep pneumoniae
lancaid shape
gram + cocci; elongated
what to use in gram stain for SF
acridine orange
-small amounts of bacteria and gets rid of cellular debris
to plate SF what plates and broth
BAP and choc
cooked meat or thioglycolate
if only 1 tube given what media and broth
choc- haemophilus
cooked meat broth
TB in sterile fluid
no digest procedure because no normal fluid to get rid of
other things found in SF
classic TB- spider web like
-enhanced in fridge
fungal culture
-cryptococcus neoformans - AIDS
-india ink
parasites
-naegleria fowleri
viral meningitis
no testing -send out
NOT as deadly as bacterial
first thing done with SF in chem
glucose values : 70% of serum values
need blood glucose first; 30 min later SF glucose
look for a decrease in glucose values bc
1 bacterial meningitis
#2 malignancy and hemorrhaging
no reason to see increase in glucose
2 thing to look for SF chem
protein
normal 15-45 in SF
normal protein in serum
6.5-8
INCREASE in protein = bad in SF
bacterial meningits
classic is increase protein and decrease glucose
decrease in protein could be
spinal fluid leak or hyperthyroidism
normal protein in SF
prealbumin
albumin
tau protein
IgG
tau protein
form of transferrin
-only found in SF!!!!
new name of prealbumin
transthyretin
not normal protein in SF
IgA and IgM
CAN:T cross barrier
to determine if blood brain barrier leak
more protein will leak into spinal fluid
how to determine if damage or synthesized protein??
spinal fluid to albumin ratio
equation for SF: albumin
SF albumin mg/dL / serum albumin g/dL
normal <9
> 9 damage to barrier
if abnormal proteins in SF normally means
MS- damage to myelin sheath
synthesize IgG
test for MS
IgG index
abnormal protein MS in gamma region
oligoclonal band- only seen in SF
90% patients with MS have
correlate both with serum
another abnormal protein seen in SF
myelin basic protein
mylein basic protein
autoantibody against sheath
glutamine
abnormal protein in SF
-if found =liver failure
-breakdown product of ammonia
reye’s syndrome
seen in children from taking aspirin during viral infection
-fatty infiltration of liver
lactate
abnormal protein seen in SF
-due to inflammatory response or hypoxia
lactate > 25 helps diagnose
bacterial meningitis
when can’t you do levels of lactate
on traumatic tap because lactate found in RBC and falsely increase
1 test for in serology
neurosyphilis
screening tests for syphilis
RPR- rapid plasma reagin
VDRL- venereal disease research lab
both look non specifically for reagin
RPR
antigen comes premade with charcoal and choline chloride
CANNOT dilute
VDRL
made daily antigen
-only FDA approved for SF
no choline chloride or charcoal
-we can dilute
ONLY USED for SF
we need to dilute antigen in VDRL because
too much antigen= post zone
other serology test for SF
cryptococcus antigen
what can give a false + in cryptococcus antigen
rheumatid factor in RA
this is IgM produced against altered IgG
SF can’t be put onto automated analyzer
not enough cells
adding albumin to a slide with concentrated SF
draws cells based on a charge
in heme do RBC count only if
true hemorrhage
if a traumatic tap and need to destroy RBC’s use
glacial acetic acid
when to do WBC count on SF
at least 1 hr of coming down or else will falsey decrease if left out
use hemocytometer
newborn normal cells are
monocytes
increase in neutrophils
bacterial meningitis
for a diff for SF
count 30 cells and report as %
not uncommon to see ____ in neonates
nRBCs
when would you see brain matter in SF
after surgery OR leukemia
large cells with round nuclei, frayed edges
lining cells
macrophage with ingested RBC
erythrophage
indication of hemorrhage
macrophage with hemosiderin granules seen in
hemorrhage
malignant cells
abnormal weird shape
most common signet
