Lesson 8 Flashcards
One of the major fluids in the body and produce a mechanical barrier to cushion
the brain & spinal cord against trauma
CEREBROSPINAL FLUID
The volume of CSF in Adult
140 to 170 ml
The volume of CSF in neonates
10 – 60 ml
What are the three layers of Meninges?
Dura mater
Arachnoid
Pia mater
“Hard mother”. Lines the skull and vertebral canal
Dura meter
“Spider web like”. A filamentous inner membrane
Arachnoid
“Gentle mother”. Thin membrane lining the surfaces of the
brain and spinal cord
Pia meter
It is Collected by lumbar puncture between the 3rd, 4th, & 5th lumbar vertebrae
SPECIMEN COLLECTION AND HANDLING OF CSF
What is TUBE 1 if STAT basis is not possible
Chemistry & Serlogy tubes are
frozen
What is TUBE 2 if STAT basis is not possible
Microbiology at room temperature
What is TUBE 3 if STAT basis is not possible
cell count to be placed inside the
refrigerator
What is TUBE 4 if STAT basis is not possible
for microbiology – to better
exclude skin contamination. For additional serologic testing
If the CSF has a Crystal clear appearance what is the Major Significance of it?
Normal
If the CSF has a Hazy, turbid, cloudy, milky appearance what is the Major Significance of it?
Meningitis
Hemorrhage,
traumatic tap
Menigngitis
Disorder that affect
blood – brain barrier
If the CSF has a Hazy, turbid, cloudy, milky appearance what is the cause of it?
WBC
RBC
Microogranisms
Protein
If the CSF has a bloody appearance what is the Major Significance of it?
Hemorrhage,
traumatic tap
If the CSF has a Xanthochromic appearance what is the Major Significance of it?
Hemorrhage, lysed
cells
RBC degradation
Increased serum
levels
Disorders that affect
the blood – brain
barrier meningeal
melanosarcoma
If the CSF has a clotted appearance what is the Major Significance of it?
Disorder affecting
blood – brain barrier
Introduced by
traumatic tap
If the CSF has a pellicle appearance what is the Major Significance of it?
disorders affecting
blood – brain barrier
introduced by traumatic tap
If the CSF has a bloody appearance what is the cause of it?
RBCs
If the CSF has a Xanthochromic appearance what is the cause of it?
Hemoglobin
Bilirubin
Carotene
Protein
Melanin
If the CSF has a clotted appearance what is the cause of it?
Protein
Clotting
factors
If the CSF has a pellicle appearance what is the cause of it?
Protein
Clotting
factors
Grossly bloody CSF can be an indication of
intracranial hemorrhage
Traumatic Collection
3 visual examinations to determine whether
the blood is the result of hemorrhage or
traumatic tap
Uneven blood distribution
Clot formation
Xanthochromic Supernatant
Traumatic tap will leave the
heaviest concentration of
blood in tube 1, and gradually diminishing in tubes 2 and 3
Uneven blood distribution
Fluid collected from traumatic tap may form clots owing to the introduction of plasma
fibrinogen
Clot formation
The result of blood that has been
present longer than that introduced by the
traumatic tap
Xanthochromic Supernatant
What are the different Cell Count?
RBC COUNT
WBC COUNT
Differential Count on CSF Specimen
Usually determined only when traumatic
tap has occurred
RBC Count
Counted in the four corner
squares and the center square on
both sides of emocytometer
Neubauer counting chamber
Normal Adult CSF Count
0 – 5 WBCs / microliter
200 WBCs or 400 RBCs – appear
clear
It is valuable in diagnostic aid
Differential Count on CSF Specimen
It is the sells found in
normal CSF
Lymphocytes & monocytes
It is seen predominance of lymphocytes to
monocytes
Adults
It is seen to be prevalence to children
Monocytes
The presence of increased numbers
of normal cells
Pleocytosis
What are the Protein Fraction?
Albumin
Pre – albumin
Alpha globulin
Transferrin
IgG
IgA
It comprises the majority of CSF
protein
Albumin
It includes haptoglobin &
ceruloplasmin
Alpha globulin
The major beta globulin present
in CSF
Transferrin
What are the Clinical Significance of an elevated total protein?
Damage to the blood brain barrier
Production of Ig within the CNS
Decreased clearance of normal protein
from the fluid
Degeneration of neural tissue
It is when fluid is leaking from the
CNS
Low values
What are the principle of turbidity production?
SSA
Trichloroacetic acid
The combination of sodium sulfate
SSA
It will precipitate the
albumin & globulin equally
Trichloroacetic acid
The advantage of using a
smaller size & less interference from external
sources
Dye-Binding techniques
In dye-binding technique it is use to bind to
variety of proteins
Use Coomasie Brilliant Blue G250
If there is a lymphocytes in CSF, what is the clinical significance of it?
Normal
Viral, tubercular and
fungal meningitis
If there is a Neutrophils in CSF, what is the clinical significance of it?
Bacterial meningitis
Early stage of viral,
tubercular, & fungal
meningitis
Cerebral hemorrhage
If there is a Monocytes in CSF, what is the clinical significance of it?
Normal
Viral, tubercular & fungal
meningitis
If there is a Macrophages in CSF, what is the clinical significance of it?
RBCs in spinal fluid
If there is a Blast Form of Cells in CSF, what is the clinical significance of it?
Acute leukemia
If there is an Ependymal, choroidal
spindle
shaped cells in CSF, what is the clinical significance of it?
Diagnostic procedures
(pneumoencephalography)
If there is a Lymphocytes in CSF, what is the microscopic findings of it?
All stages of
development
may be found
If there is a Neutrophils in CSF, what is the microscopic findings of it?
Granules may
be less
prominent in
blood
If there is a Monocytes in CSF, what is the microscopic findings of it?
Found mix with
lymphocytes
If there is a Macrophages in CSF, what is the microscopic findings of it?
May contain
phagocytized
RBCs
appearing as
empty vacuoles
or ghost cells
If there is a Blast Form Cells in CSF, what is the microscopic findings of it?
Lymphoblast, myeloblast, monoblasts
If there is a Ependymal, choroidal
spindle
shaped cells in CSF, what is the microscopic findings of it?
Appears in
clusters
Detection of oligoclonal bands representing inflammation within the CNS
Electrophoresis
What diagnosis is the presence of 2 or more oligoclonal bands in the
CSF not present in the serum?
Diagnosis of multiple sclerosis
This are the diagnosis of multiple sclerosis
Encephalitis
Neurosyphils
Neoplastic disorders
It is seen in meningitis cases
Cerebrospinal flulid lactate
What is the normal values of plasma
glucose
60 – 70%
It is produced in the CNS by the brain cells
from ammonia & α – ketoglutarate
CSF Glutamine
Meningitis, bacterial
meningitis, tubercular meningitis, what CSF glucose is this?
Low CSF glucose
Viral meningitis, what CSF glucose is this?
Normal CSF glucose
75% of children with this syndrome
have elevated CSF glutamine levels
Reye’s syndrome
normal value of CSF Glutamine
8 – 18 mg / dl
What type of test is used to Identify the causative agent of
meningitis
MICROBIOLOGY TESTS
It is the protein determination of CSF
Chemistry Tests
The concentration of the protein present will determine the amount of blue color produced
Beer’s Law
