LP

Question 1

LP

Answer 1

performed by inserting a hollow needle into the subarachnoid space—-the area that carries CSF between the brain and spinal cord

Question 2

CSF

Answer 2

Clear fluid that protects spinal cord composed of cells, water, proteins and sugars

Question 3

What are the indications for perfoming a CT before LP

Answer 3

pt. older then 60
immunocompromised
pt. c cns lesions
pt. who has had a seizure 1 wk prior to presentations
AMS
Pt. with focal neurological findings

Question 4

What is the most common neurologic manifestation of elevated ICP

Answer 4

Papilledema which can lead to blindness

Question 5

Risk of LP

Answer 5

H/A
Infection
Numbness/pain Temp
Bleeding in spinal canal
may cause brain herniation

Question 6

How to perform LP

Answer 6

Pt. lies on side with chich tucked to chest and kness to abd.
OR
Pt sits on the edge of the bed with arms draped over table positioned in front of pt.
Either postion back is arched, helps widen intervertebral spaces
Sterile proceduce, cleans back with antiseptic soliton plus drape with sterile towels, sterile gloves, anesthetize area, hollow needle bevel up. collect 10 drops in 4 test tubes
Position pt flat on back for 1 hr post procedure, rehydrate pt.

Question 7

Where does a LP occur

Answer 7

L3-L4 or L4-L5

Question 8

CSF Normal Values

Answer 8

Opening pressure:

Question 9

Increase in neutrophils

Answer 9

bacterial meningitis, tubercular meningitis, cerebral abscess, subarachnoid bleed, tumor

Question 10

increase in lymphocytes

Answer 10

viral, tubercular, fungal, syphilitic meningitis, MS, GB syndrome

Question 11

Increase in Eosinophils

Answer 11

parasitic meningitis, allergic reaction to radiopaque dyes

Question 12

Increase in macrophages

Answer 12

tubercular, fungal meningitis, hemorrhage, brain infarction

Question 13

Increase in protein

Answer 13

infectious or inflammatory disease, meningitis, encephalitis, myelitis, CNS tumor

Question 14

Decreased Gluscose

Answer 14

Bacterial, inflammatory cells or tumor cell

A CSF glucose level less then 60% of drawn blood glucose level may indicate meningitis or neoplasm

Question 15

CSF change in color

Answer 15

Hyperbilirubinemia, hyperkarotenemia, melanoma, elevated protein levels= yellowish tinge
Cloudy= increase in WBC or protein

Question 16

Bacterial Meningitis

Answer 16

Appearance: Clear, cloudy, or purulent

Opening pressure: Elevated (>25 cm H2o

WBC count: >100 cells/μL (>90% PMN); partially treated cases may have as low as 1 WBC/μL

Glucose level: Low (50 mg/dL)

Question 17

Aseptic Viral Meningitis

Answer 17

Appearance: Clear

Opening pressure: Normal or elevated

WBC count: 10-1000 cells/μL (lymph but PMN early) •

Glucose level: >60% serum glucose (may be low in HSV infection)

Protein level: Elevated (>50 mg/dL)

Question 18

Fungal Meningitis

Answer 18

Appearance: Clear or cloudy

Opening pressure: Elevated

WBC count: 10-500 cells/μL

Glucose level: Low

Protein level: Elevated

Question 19

TB

Answer 19

Appearance: Clear or opaque

Opening pressure: Elevated

WBC count: 50-500 cells/μL (early PMN then lymph)

Glucose level: Low

Protein level: Elevated

Question 20

Subarachnoid Hemorrhage

Answer 20

Appearance: Xanthochromia, bloody, or clear

Opening pressure: Elevated

WBC count: (1 additional WBC per 1000 RBCs is considered normal correction)

Glucose level: Normal

Protein level: Elevated

Question 21

MS

Answer 21

Appearance: Clear

Opening pressure: Normal

WBC count: 0-20 cells/μL (lymph)

Glucose level: Normal

Protein level: Mildly elevated (45-75 mg/dL)

Question 22

Guillian Barre Syndrome

Answer 22

Appearance: Clear or xanthochromia

Opening pressure: Normal or elevated

WBC count: Normal or elevated

Glucose level: Normal

Protein level: Elevated