Lumbar puncutre Flashcards
ph of csf
7.33 - 7.35
function of csf
shock absober for cns
immunologicla funciton
where is csf mainly produced
95% in laterl venticle
4th ventilce
what produces csf
choroid plexus
what is the ammmoujt of csf produced in 24 hours
450 - 750 mls/ 24 hours
how much csf is proudced by new borns and peads each day
25 mls new born
125 peads
what is the csf turn over
3 times per day
what is the volume of csf in adults
150 mls
what is the pressure in cm of csf
less than 15 with a mean of 10 , and between 9 - 12 in peads
how is csf absobped
by arachnoid villi projectsion of the aracnoid memnare into the dural sinsus to allow csf to pass form th subarachnoid space in to the venous system
what is the osmolatir of csf and how does it compare to plasma
it is the same as plasma - 295
what cells are not prenst in csf that re in blood
rbc, neutrophils, eosinophils, basophils, and mast cells. P
what is lower in csf compared to plasm
potasium, calcium , glucoise , proteing (signifcanlty) , albumin (signficialty) , Igg (signficilay)
what is higher in csf compared to plasma
clorine, lactose and water
what cells are seen in bacterial csf infection
leurkocytes, nurepils, low gluose, hihg protines, high opening pressure
what is seen in viral csf infection
slightly elevated opening pressure
slightl high leukocytes
if early - nerutropils, if late lymphocytic
low glucose
high protein
what is seen in fungal csf infection
high opeing pressure
mid leukocytes
lymphhoctyes
low glucose
hgigh protien
postive to cultures
what is seen in tb infection
fibrin web appareach
different opening pressure
hihg lymhoctyes,
lympocytes high
low glucose
very high proin
positive for afb
what is seen in autimmine infection of csf
clear liquid
normal opeingi pruss
raided lueckiphyils
lymphocytes
normal glucose
high protein
negative to cultrues
what to check before lumbar pucutes
any anticogaulatis and check coagulation
look for previous surgyes
look for brain tumour - which could lead to a death if tapped
congetila abnomaleis
what are the congential abnoralies that a spinal tap should be avoided
chiari malforamtion, bifida
what posistion should someone be in for lumbar punctture
lateral decubitus
what is the level of lumbar punctre in adults/ childnr
adults - l3, or opposite supperio illiac spine
child below l4
conuc medual end point adults and childern
adults - l1/l2
child - l2/l3
how to do lumbar punctures
insert needle along midline
having te point of needle of the centre
when feel pop put needle pull back to look for csf
tnrn need to venture
attachn manometer to hymb of needle and measure the pressure and collect csf fluid
why would a lumbar puncutre be required
look for
tb, cns symphyisl, cns vasulitis, ms, gullian barre syndoem, tansvere myelits, menigitis, subaracnoid heamortage
what is tharputic lumbar puncture uses
spinal anethetic, injection of contrat media for myelography, treatment of reaide dinternactial presu post subarnoid bleed hydrocephalus hc, treat idiopathic intracrtal hyertenison
injection of contrast media for myelography
what is hydrocephauls
where there is abdnomla build up of fluid within the ventrilces of the brain
types of hydrocephauls
subnomral csf reabospriton of csf overprodution
causes of hydrocepalus
obstuctive - e.g. stenois of aqueduct of sylvius
communicating - defective reabospin in arachnoid granultion nomarlly due to csf overpuditon by tumorus
tumor of choroid plexus
choroid plexus papillomas
symptomns and signs of hydrocephaus in adults
Headache
Nausea, vomiting
Gait disturbance ( unsteady)
Papilledema, blurred vision, reduced vision
Abducens palsy
Up gaze palsy
Reduced conscious level
Urinary incontinency
Altered mental status
Poor concentration
sympotns and signs of hydocephauls in childrne
Abnormal increased head circumference (OFC)
Irritability
Poor head control
Poor feeding, N/V
Bulging and full fontanelle,
Prominent forehead (frontal bossing),
Enlargement and engorgement of scalp veins
McEwen’s signs: cracked pot sound on percussing over –dilated ventricles
Abducens palsy
Upward gaze palsy ( sun setting sign)
Hyperactive reflexes
Irregular respirations with apneic spells
Splaying of cranial Sutures
cause of congetial hydorpculs
chiarail malformaiton
priarmy aqueduct stenois
dandy walker malforamtin ie. atreatsi of fomraiton of luschka and magendie
what is chiari malformation
where the cerebllum misformes and bulges towards the spinal canal blocking it
etilogy of hydorpchs
post heamorrage, post infection, brain tumour
types of hydrocephaulus
idiopathic, intracrail hyperenteniosn, female, obse
invesigation s for hydrocephauls
Clinical assessment of the patient and history
Ultrasound
CT head
MRI head ( different sequences)
treatment for hydrocephauls
Fontanel tap
Ommaya reservoir
External Ventricular Drain ( EVD)
Lumbar puncture
Lumbar drain
Ventriculo-peritoneal Shunt
Ventriculo-Atrial shunt
Lumbo-peritoneal shunt
what is hte ommaya revosu
port just above head that has a father that isn inserted into the ventilce, alow easily table to take csf
what is a venticlr atrail shunt
port from the ventilce in brain into the right arturm though father in heart
how is shunts reguated
through a vavle
