Lumber Puncture Flashcards
List 4 reasons that indicate lumbar puncture
primary or metastatic neoplasm, cerebral hemorrhage, meningitis, encephilitis
from what space is CSF obtained
subarachnoid
What is normal P for CSF
70-200 mm H2O
What is a normal WBC count in CSF
0-5 cells/mcL adult (0-20 for kiddos)
Which WBC type makes up 40-80% of CSF
lymphocytes
What is the normal protein value in CSF
15-45 mg/dL
What is the normal glucose value in CSF
50-75 mg/dL (60-70% of serum glucose. serum levels must be taken before LP)
What is the normal Cl value in CSF (not normally tested)
700-750 mg/dL
serology is performed on CSF to screen for what condition
neurosyphils
what 2 conditions present with increased (>40 units/L) CSF lactate dehydrogenase (LDH)
inflammation or bacterial meningitis (produced by neutrophil)
4 ways bacterial meningitis (MCC strep pneumoniae) would present in CSF values
200-20,000 PMNs, glucose50 mg/dL
4 ways aseptic meningitis would present in CSF values
25-2,000 LYMPHOCYTES, glucose normal to low, proteins>50 mg/dL, slightly increased P
4 ways granulomatous meningitis would present in CSF values
100-1,000 LYMPHOCYTES, glucose < 45, slightly increased P, Protein >50 mg/dL
why is opening pressure increased for lumbar puncture (4)
tumors, infection, hydrocephalous, intercranial bleeding
why is opening pressure decreased for lumbar puncture (3)
hypovolemia (shock or dehydration), chronic leakage of CSF (previous puncture site), nasal sinus fracture
2 ways to differentiate between a traumatic tap and a subarachnoid bleed
traumatic tap will show clotting (if no blood thinners) and the redness should decrease in the fluid when it starts flowing
what is yellow tinged CSF called? what can it indicate (3)?
xanthochromia= hyperbilirubinemia, hypercarotenemia (normal in kiddos), melanoma
cerebral absess and bacterial meningitis both present with these WBCs in CSF
PMNs
In what conditions are mononuclearleukocytes elevated in CSF (3)
viral infection, tubercular infection, encephalitis
4 examples of noninfectious menigeal irritation
carcinomatosis, sarcoidosis, SLE, chemical menigitis
3 ways noninfectious meningitis would present in CSF values
increased WBC count, increased protein, low or normal glucose
what form of meningitis is most common in young adults and teens
Neisseria menigitidis
4 most common causes viral (aseptic) meningitis
Herpes simplex, Coxsackievirus, Echovirus, Infectious mononucleosis
4 most common causes of encephalitis
Herpes simplex, arbovirus, rabies virus, flavivirus (West Nile and Japanese)
Conditions tested in CSF protein electrophoresis
multiple sclerosis, neurosyphilis, immunogenic degenerative processes
Conditions where lactic acid of CSF is increased
anaerobic metabolism (low blood flow or decreased oxygenation), bacterial infections, fungal infections, low CSF glucose
Tumor markers used in CSF
CEA, Alpha-fetoprotein, hCG
