LPs

Question 0

CSF – normal glucose? protein? white cells? Opening pressure?

Answer 0

Two thirds blood glucose;
50 mg/dL protein;
WBCs<5;
60-150 mm H2O

Question 1

In adult, spinal cord ends at what level?

Answer 1

L1-2

Question 2

After doing LP, notice yellow discoloration of supernatant – name? Suggest?

Answer 2

Xanthochromia; subarachnoid hemorrhage or hemorrhagic encephalitis (no traumatic tap)

Question 3

Disease if CSF indicates –

1. Oligoclonal banding
2. 14,3,3-protein

Answer 3

1. Autoimmune disease (Multiple sclerosis)

2. Creutzfeldt-Jacobs disease

Question 4

Most dangerous complication of lumbar puncture? This occurs when? Prevented by?

Answer 4

Cerebral or cerebellar herniation; supratentorial or infratentorial mass lesion

CT scan before LP

Question 5

Instance in which LP should be done without first obtaining CT scan?

Answer 5

Suspected meningitis

Question 6

Radiologic contraindications to LP?

Answer 6

#Closure of the fourth ventricle
#quadrigeminal cistern

Question 7

Most common complication of LP? Management?

Answer 7

Low-pressure headache

#Have patient lie flat
#Increase fluid/caffeine intake
#Epidural blood patch

Question 8

LP shows polymorphs – suspect? If lymphocytes?

Answer 8

Bacterial or early viral infection

#Viral/fungal/mycobacterial infection
#Demyelination
#CNS lymphoma

Question 9

LP shows elevated protein – differential?

Answer 9

#Infection – fungal/mycobacterial
#Tumor – meningioma, carcinomatous meningitis
#Demyelination
#Sarcoidosis
#Age

Question 10

LP shows low glucose – suspected cause?

Answer 10

Bacterial or mycobacterial infection

Question 11

CSF shows oligoclonal bands – differential?

Answer 11

#Infection (Lyme disease)
#Noninfectious inflammatory process (SLE)
#Demyelination (MS)
#Acute disseminated encephalomyelitis

Question 12

Immunocompromised patient has positive EBV PCR of CSF – suggests?

Answer 12

CNS lymphoma

Question 13

CSF shows:

1. polymorphs, high-protein, low glucose
2. Lymphocytes, high-protein, normal glucose
3. Lymphocytes, high-protein, very low glucose
4. No white cells, high-protein, normal glucose
5. Few lymphocytes, slightly high-protein, normal glucose and oligoclonal bands
6. Lymphocytes or polymorphs, high protein, normal glucose, oligoclonal bands

Answer 13

1. Bacterial meningitis
2. Viral meningitis/encephalitis
3. Tuberculosis meningitis
4. Guillain-Barré
5. MS
6. Acute disseminated encephalomyelitis