LP and CSF Flashcards
how much CSF is there normally?
150ml
how much CSF is produced daily?
500ml
how many times is CSF replenished completely?
3
which epithelial layer produces CSF?
choroid plexus
what helps CSF flow around?
beating cilia
where is the main production of the CSF?
lateral ventricles
what structure resorbs the CSF?
in what space is this structure located?
arachnoid villi
sub-arachnoid space
through what two foramens does CSF get into the sub-arachnoid space?
foramen of luschka & magendie
through what structure does CSF flow in the 3rd ventricle?
through what structure does CSF flow into the 4th ventricle?
foramen of monro
cerebral aqueduct
outline the flow of CSF?
-8
lateral ventricles
(main production)
↓
foramen of
monro
↓
3rd ventricle
↓
cerebral aqueduct
↓
4th ventricle
↓
via foramen of luschka & magendie & spinal cord opening
↓
sub-arachnoid space
↓
Arachnoid villi
(reabsoprtion)
most common side effect after lumbar puncture?
how do you manage this se?
headache
analgesia + rest
most severe se of LP?
explain mechanistically how this se can happen?
brainstem herniation
pt has high ICP –> LP causes big drop in ICP –> quick pressure drop can suck out brainstem
between which vertebrae do you do the LP?
l4/l5
what device is used to measure the pressure when doing LP?
Manometer
route of needle in LP?
Skin ↓ SCfat ↓ back muscles ↓ supraspinous ligametnum, ↓ ligamentum flavum ↓ sub-arachnoid space.
what are the polymorph cells?
neutrophils (BEN)
what are the mononuclear cells?
lymphocytes
if pt has autoimmune disease.
what is the hallmark result seen on LP?
oligoclonal bands
RBC in CSF on doing LP.
what is this a sign of?
trauma
in a viral infection CSF fluid is usually what appearance?
clear
in a bacterial infection CSF fluid is what appearance?
turbid
in a fungal infection CSF fluid is what appearance?
turbid
pt has viral infection.
which cell type increase in the CSF?
mononuclear (lymphocytes)
pt has pyogenic infection.
which leukocyte type increase in the CSF?
Polymorphs
neutrophils
pyogenic infection is a synonym for what microbial infection?
bacterial
in which infection type does glucose decrease in CSF?
pyogenic (bacterial)
in which infections does protein levels increase in CSF?
-name all if more than one
pyogenic
viral
fungi
CI for an LP?
-5
raised idiopathic CSF bleeding disorders warfarin clopidogrel MSK deformities
which ligament comes after supraspinous ligament?
ligamentum flavum
which ligament precedes sub-arachnoid space?
ligamentum flavum
you put needle through someone’s back.
what is the first ligament you hit?
supraspinous ligament
which two medications (name them) if pt is on them means LP is contraindicated?
warfarin
clopidogrel
in which infection type does protein increase a lot on LP?
pyogenic (bacterial)
why does glucose decrease on LP in bacterial infection?
bacteria using glucose
why does bacterial infection have very very high protein in LP?
so much bacteria you just end up measuring the bacteria’s protein
