MIDTERM - CSF Flashcards
The brain and spinal cord are lined by the ____, which
consists of three layers
meninges
function of csf
- supply nutrients to the nervous tissue,
- remove metabolic wastes,
- produce a mechanical barrier to cushion the brain and spinal cord against trauma.
three layers of meninges of the brain and spinal cord
dura mater - hard mother
arachnoid - spider web like
pia mater - gentle mother
The outer layer is the dura mater
that lines the __ and ___
skull and vertebral canal
the arachnoid is a ___ inner membrane
filamentous
the pia matter is a ___ membrane lining the ___ of the brain and the spinal cord
thin; surfaces
CSF is produced in the ____ of the TWO lumbar ventricles and the third and fourth ventricles. I
choroid plexuses
In adults, approximately ___mL of fluid is produced every hour
20 ml per hr
mnemonic for csf flow
come - choroid plexus
let - lateral ventricle
me - foramen of monroe
treat - third ventricle
sylvia - sylvian aqueduct
for - fourth ventricle
lunch - foremen of luschka
mamaya - foramen of magendie
sa - subarachnoid
aristocrat - arachnoid
In adults, we are maintaining how many ml of circulating csf?
90-150 ml
In neonates, we are maintaining how many ml of circulating csf?
10-60 ml
since the choroid plexus is producing csf of 20 ml per hr, how do we maintain a constant 90-150 ml of csf for adult and 10-60 ml for neonates?
it will be reabsorbed back into the blood capillaries in the ARACHNOID GRANULATION/VILLAE at a rate equal to its production
explain why arachnoid granulation acts as a one way valve
it responds in the pressure within the CNS and prevent reflux of fluid
how do plasma differs in csf in terms of chemical composition, even though csf came from plasma?
it was been filtered out by the choroid plexus. Also, when it comes to endothelial cells found in other parts of the body, it is all loosely connected, however, in the choroid plexus, it is tight fitting and will prevent the passage of unnecessary molecules
Tight-fitting structure of the endothelial cells in the choroid plexuses is termed the ___ that prevent the passage of many
molecules
blood–brain barrier
give an example of disease that causes disruption in blood brain barrier
meningitis
The ___ are capillary networks that form
the CSF from plasma by mechanisms of selective
filtration under hydrostatic pressure and active
transport secretion
choroid plexuses
The procedure for obtaining CSF is known as a
Lumbar Puncture
Contraindication to performing this puncture is the
presence of __at the puncture site.
infection
____ mL of CSF is slowly removed into three or four sterile tubes that are numbered sequentially
10–20
If only one tube can be collected, it must be tested first
by ___
microbiology
Tube 1 -
Tube 2 -
Tube 3 -
Tube 1 - Chemistry serology
Tube 2 - Microbiology
Tube 3 - Hematology
To maintain a volume of
90 to 150 mL in adults and 10 to 60 mL in neonates, the circulating fluid is reabsorbed back into the blood capillaries in
the ___ at a rate equal to its pro
duction.
arachnoid granulations/villae
The cells of the arachnoid granulations act as ___ valves that respond to pressure within the central nervous system (CNS) and prevent ___ of the fluid
one-way; reflux
the selective filtration of plasma to form a csf is regulated by what processes
hydrostatic pressure and active transport secretion
Maintaining the integrity of the blood–brain barrier is
essential to protect the brain from chemicals and other sub
stances circulating in the blood that could harm the brain tis
sue.
true or false
true
if there’s an elevated pressure upon collection, we must collect a sample ____
slowly
CSF is routinely collected by lumbar puncture between the ____, ___, ____ lumbar vertebra.
third, fourth, or fifth
Tube 1 is used for chemical and serologic tests because
these tests are ____introduced as a result of the tap procedure
least affected by blood or bacteria
Tube 2 is usually designated for the ___
microbiology
laboratory
Tube 3 is used for the cell count (hematology), because it is the ___ introduced by the spinal tap procedure.
least likely to contain cells
A fourth tube may be drawn for the microbiology laboratory to better exclude skin contamination or for additional
serologic tests.
true or false
true
__ that is left over after each section has performed its tests may also be used for additional
chemical or serologic tests.
Supernatant fluid
Excess fluid should not be ___and should be ___until there is no further use for it
discarded ; frozen
Ideally, tests are performed on a STAT basis. If this is not possible, specimens are maintained in the following manner:
- Hematology tubes are ___.
- Microbiology tubes remain at ___
- Chemistry and serology tubes are ___.
- Hematology tubes are refrigerated.
- Microbiology tubes remain at room temperature.
- Chemistry and serology tubes are frozen.
mnemonic for storing csf per section
csf - chem sero in freezer
mrt - microbio room temp
hr - hematology refrigerated
normal appearance of CSF
crystal clear
A ____appearance can be the result of an increased protein or lipid concentration, but it may also be indicative of infection with the ____ being caused by the presence
of WBCs
cloudy, turbid, or milky specimen
is a term used to describe CSF super
natant that is pink, orange, or yellow.
Xanthochromia
A variety of factors can
cause xanthochromia, the most common being the presence
of ___
RBC degradation products
colors that the xanthochromic csf can turn into
from pink to orange to yellow
a pink colored xanthochomic csf signifies
slight amount of oxyhemoglobin
a orange colored xanthochomic csf signifies
heavy hemolysis
a yellow colored xanthochomic csf signifies
conversion of oxyhemoglobin to unconjugated bilirubin
Other causes of xanthochromia
include
serum bilirubin, presence of the pigment
CAROTENE, markedly increased protein concentrations, and
melanoma pigment
Xanthochromia that is caused by bilirubin
due to immature liver function is also commonly seen in infants, particularly ____.
premature infants
Blood from a ____ will be evenly distributed
throughout the three CSF specimen tubes, whereas a traumatic
tap will leave the heaviest concentration of blood in tube 1, and gradually diminishing amounts in Tubes 2 and 3.
cerebral hemorrhage
Fluid collected from a ___ may form clots owing to
the introduction of plasma fibrinogen into the specimen
traumatic tap
Bloody CSF caused by __ does not contain enough fibrinogen to clot.
intracranial hemorrhage
conditions that will causes clot formation but not necessarily has a presence of blood, the reason behind is only because of the introduction of the plasma fibrinogen caused by the damage of the blood brain barrier
meningitis, Froin syndrome, and blocked CSF circulation through the subarachnoid space
A classic web-like pellicle is
associated with ___ and can be seen after
overnight refrigeration of the fluid.
tubercular meningitis
The cell count that is routinely performed on CSF specimens
is the ____ count
leukocyte (white blood cell [WBC])
. Any cell count should be per
formed immediately, because WBCs (particularly granulocytes)
and RBCs begin to lyse within _____ hour,
1 hr
ny cell count should be per
formed immediately, because WBCs (particularly granulocytes)
and RBCs begin to lyse within 1 hour, and ___ % of the leukocytes disintegrate after ___- hrs
40% ; 2 hours.
Normal adult CSF contains ___ WBCs/ L
0 to 5
possible causes of hazy, turbid, milky, and cloudy appearance
wbc, microorganism, protein
significance of hazy, turbid, milky, and cloudy csf appearance
- Meningitis
- Disorders that affect
blood-brain barrier &
Production of IgG
within the CNS
bloody appearance of csf might be a cause of
rbc
significance of bloody apearance in the urine
hemorrhage and traumatic tap
causes of clotted appearance
protein and clotting factors
significance of clotted csf
disorder affecting blood-brain barrier
introduced by traumatic tap
possible causes of xanthochromic appearance in the csf
hemoglobin
bilrubin
carotene
protein
melanin
significance of a xanthochromic appearance of a urine which a possible cause is hemoglobin
- old hemorrhage
- lysed cells from traumatic tap
significance of a xanthochromic appearance of a urine which a possible cause is bilirubin
rbc degradation
elevated serum bilirubin level
significance of a xanthochromic appearance of a urine which a possible cause is carotene
increase serum level
significance of a xanthochromic appearance of a urine which a possible cause is protein
disoders affecting blood brai barrier
significance of a xanthochromic appearance of a urine which a possible cause is melanin
meningeal melanosarcoma
possible cause of pellicle appearance in the csf
protein and clotting factors
significance of a pellicle appearance in the urine are
disorders that affect blood brain barrier
tubercular meningitis
the diluting fluid we can use for wbc count
3% glacial acid - to lyse rbc
add methylene blue to differentiate neutrophils and mononuclear cells
stain used for differential count
wright stain
for total cell count, Clear specimens may be counted undiluted, When dilutions are required which pipette are used?
calibrated pipette
Dilutions for total cell counts are
made with ___-, mixed by inversion, and loaded into
the hemocytometer with a Pasteur pipette.
normal saline
The speed of the cytocentrifuge
should be checked monthly with a ___, and the timing
should be checked with a ___
tachometer; stopwatch
If nondisposable counting chambers are used, they must
be soaked in a bactericidal solution for at least __ and then thoroughly rinsed with water and cleaned with isopropyl
alcohol after each use.
15 minutes
Methods available for specimen concentration include
___
sedimentation, filtration, centrifugation, and cytocentrifugation
Among the concentration technique, ___ and ____ are not routinely used in the
clinical laboratory, although they do produce less cellular distortion.
Sedimentation and filtration
. Most laboratories that do not have a cytocentrifuge concentrate specimens with routine centrifugation, how will they proceed?
The specimen is centrifuged for 5 to 10 minutes, supernatant fluid is
removed and saved for additional tests, and slides made from
the suspended sediment are allowed to air dry and are stained
with Wright’s stain.
In addition to bacterial meningitis, increased neutrophils
also are seen in the early stages (1 to 2 days) of __
viral, fungal, tubercular, and parasitic meningitis
Neutrophils associated with bacterial meningitis may contain
___
phagocytized bacteria
Neutrophils with ___ indicate degenerating
cells
pyknotic nuclei
NRBCs
are seen as a result of ___ contamination during the
spinal tap
bone marrow
The purpose of ___ in the CSF is to remove cellular
debris and foreign objects such as RBCs.
macrophages
Macrophages appear
within___ hours after RBCs enter the CSF and are frequently
seen following repeated taps
2 to 4
The finding of increased macrophages indicates a ___
previous
hemorrhage
They are iron-free, consisting of hemoglobin and unconjugated
bilirubin
yellow hematoidin crystals
Nonpathologically significant cells are most frequently seen
after diagnostic procedures such as
pneumoencephalography
what are the example of Non Pathologically
significant cells
- Choroidal cells
- Ependymal cells
- Spindle shaped cells
hematologic malignant cells
- Lymphoblast
- Myeloblast
- Monoblast
- Lymphoma cells
Nonhematologic malignant cells
- Astrocytoma
- Retinoblastoma
- Medulloblastoma
nonpathological cells that Are from the epithelial lining of the choroid
plexus
choroidal cells
choroidal cells - They are seen singularly and in clumps
true or false
true
a nonpathological cells that Are from the lining of the ventricles and neutral
canal
Ependymal cells
a nonpathological cells which have less defined cell membranes and are
frequently seen in clusters
Ependymal cells
a non pathological cells that Represents lining from the arachnoid
spindle shaped cells
a nonpathological cells that are usually seen in clusters and may be
seen with systemic malignancies
what is the normal value of csf protein in adult , infant, and immature infants
○ Adults: 15 to 45 mg/dL
○ Infants: 150 mg/dL
○ Immature: 500 mg/dL
csf proteins increase in the presence of
Damage to BBB (Meningitis, Hemorrhage)
Production of Igs in CNS (Multiple Sclerosis)
decrease in csf proteins are seen in
CSF Leakage
what is the major protein found in csf?
albumin
2nd most found protein in csf
prealbumin
alpha globulin found in csf
haptoglobulin and ceruloplasmin
b globulin found in csf
b transferrin
a protein that can be found in the csf but not in serum
y globulin - IgG and IgA
a separate carbohydrate-deficient transferrin fraction, referred to as
“___,” is seen in CSF and not in serum
tau
proteins we can’t found in csf
IgM, fibrinogen and lipids
protein determination for total protein
1.turbidimetry - nephelometry
2. dye-binding
protein determination
dye-binding, chons bind to dye which turn the dye to turn red to __
blue
the blue color in total protein determination of dye binding signifies
increased protein
a protein determination that is for the detection of oligoconal bands in g rehion which is an indicative of IgG production
electrophroresis
in electrophoresis for the protein determination, the prsence of 2 or more oligoclonal bands in csf but not in serum is valuable for the diagnosis of ___
multiple sclerosis
ther neurologic dis
orders including encephalitis, neurosyphilis, _____, and neoplastic disorders also produce oligoclonal
banding that may not be present in the serum
Guillain-Barré syndrome
it is the protein component of lipid-protein complex that insulates the nerve fibers
myelin basic protein
t is used to monitor the course of multiple sclerosis
myelin basic protein
how many percent to csf glucose constitute in serum plasma?
60-70 %
decrease in glucose
increase neutrophils
signifies ___
bacterial infection
decrease in glucose
increase in lymphocytes
signifies ___
tubercular infection
no glucose
increase lymphocyte
signifies
viral infection
clinical significance of protein in csf
- damage to the blood-brain barrier
- Production of immunoglobulins
within the CNS - decreased clearance of
normal protein from the fluid - degeneration of neural tissue.
a presence of lactate that is >25mg/dl indicates
Bacterial, tubercular,
fungal meningitis:
a presence of lactate that is >35mg/dl indicates
bacteria meningitis
a presence of lactate that is <25mg/dl indicates
viral menigitis
Lymphoblasts, myeloblasts, and monoblasts in the CSF are frequently seen as a serious complication of __
acute leukemias.
Lymphoma cells are also seen in the CSF and indicate dissemination from the ___
lymphoid tissue
Metastatic carcinoma cells of nonhematologic origin are primarily from ___
lung, breast, renal, and gastrointestinal malignancies.
Cells from primary CNS tumors include ___, ____, ___
astrocytomas, retinoblastomas, and medulloblastomas
Fusing of cell walls and nuclear irregularities
and hyperchromatic nucleoli are seen in clusters of ___.
malignant cells
The most frequently performed chemical test on CSF is the
___
protein determination
The presence of___ in the CSF indi
cates recent destruction of the myelin sheath that protects the
axons of the neurons (demyelination).
myelin basic protein (MBP)
___
techniques are used for measurement of MYB
Immunoassay
is produced from ammonia and alpha - ketoglutarate by the brain cells
glutamate
The normal con
centration of glutamine in the CSF is ___
8 to 18 mg/dL
Elevated levels of glutamate are associated with ___ that result in increased
blood and CSF ammonia.
liver disorders
bacterial culture for csf will take how many hrs or days/
24 hrs
tubercular culture of csf will take how many days or weeks?
6 weeks
what is the gram posistive cocci usually recovered in csf
Streptococcus
pneumoniae
what is the gram negative rods usually recovered in csf
Haemophilus influenzae
escherichia coli
what is the gram negative cocci usually recovered in csf
Neisseria meningitidis
Test for fungal
Meningitis ( Crypto
coccus neoformans)
it uses 2 stains
- India ink
preparation - Grams stain =
starburst pattern
The gram-positive cocci __- and the
gram-positive rods __- may be encountered
in newborns.
Streptococcus agalactia; steria monocytogenes
As one of the more frequently occurring complications of AIDS, ___ is now
commonly encountered in the clinical laboratory
cryptococcal meningitis
___ tests to detect the presence of C. neoformans antigen in serum and CSF provide a more sensitive
method than the India ink preparation
Latex agglutination
immunologic testing results should be confirmed by culture and
demonstration of the organisms by India ink, because false
positive reactions do occur.
Interference by ___
is the most common cause of false-positive reactions
rheumatoid factor
Birth to 1 month common causative bacterial meningitis agents
Staphyloccos agalactiae
1 month to5 years old common causative bacterial meningitis agents
haemophilus influenzae
5 to 19 yo common causative bacterial meningitis agents
Neisseria meningitides
> 29 yo common causative bacterial meningitis agents
staphylococcus pnemonia
Infants, elderly,
immunocompromised common causative bacterial meningitis agents
L monocytogenes
___ test for syphilis.
fluorescent treponemal antibody-absorption
(FTA-ABS)
Neurosyphilis test
Venereal Disease Research Laboratories (VDRL)
test is not
recommended because it is less sensitive than theb VDRL
Rapid Plasma Reagin (RPR)
