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Microscopy > CSF > Flashcards

CSF Flashcards

1
Q

Why is CSF volume important

A

If too much: hydrocephalus
BBB compromised, intracranial pressure

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2
Q

CNS membranes

3

A

Dura mater (outermost)
Arachnoid
[CSF here]
Pia mater (innermost)

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3
Q

CSF production

A

Brain secretions and plasma filtrate
- One way reabsorption valves for waste

Selective filtration of plasma so chemical composition is different from ultrafiltrate plasma

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4
Q

Fluid output rate

A

20 ml/hr

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5
Q

Blood brain barrier

A

Tight capillary endothelium that creates CSF
- substances pass through the cells, atransport/diffusion

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6
Q

CSF volume for ages

A

Adults: 90-150 mls
Infants: 10-60 mls

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7
Q

CSF components compared to plasma

A

CSF has more: Na, Mg, Cl
less: glucose, K, bicarb, protein

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8
Q

CSF collection procedure

age, volume, pressure

A

Adults: between L3 L4
Children: between L4 L5

10-20 mls removed

50-180 mmHg pressure normal

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9
Q

Collection tube order

and why

A
  • 1: chem/serology because least affected by blood or bacteria introduced as a result of the procedure
  • 2: micro
  • 3: heme/cell count
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10
Q

Collection tube storage

A
  • Heme: fridge up to 4 hrs
  • Micro: room temp
  • Chem/sero: frozen
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11
Q

CSF that is colored: term

A

Xanthochromic

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12
Q

Pleocytosis

A

Increased wbcs and rbcs: cloudy specimen

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13
Q

Clotting in CSF

A

ALWAYS ABNORMAL
- fibrinogen and plasma proteins
- can be from pellicle formation after fridge
- common in traumatic taps

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14
Q

Proteins in CSF

A

15-45 mg/dl can be normal, prealbumin, albumin, transferrin
Increased: infections, tumors, hemorr, cns disorders
Decreased: dural tear, cranial pressure

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15
Q

Reasons for proteinsin CSF and difference

A

Impaired BBB: most cases, albumin
Increased synthesis: less common, IgG

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16
Q

Normal ratio for albumin

A

<9

17
Q

Normal ratio for IgG

A

<8

18
Q

IgG index formula

A

(IgG CSF/IgG serum) x (albumin serum/CSF albumin)

Normal: 0.3 - 0.7
- Increased: MS, neuro probs
- Decreased: BBB bad

19
Q

BBB damage vs CNS synthesis in relation ot the ratios

A

BBB damage: increased albumin AND IgG ratio, decreased IgG index

CNS synthesis: normal albumin, IgG ratio and IgG index increased

20
Q

Glucose in CSF

A

ratio compared to serum is 0.6 normal
Decrease: increased glycolysis, some cancers, transport issues
Increase: bloody tap, hyperglycemia

21
Q

Lactate in csf

A

Normal: 11-22 mg/dk

Increase: tissue hypoxia

Viral: <30 mg/dl

Bacteria, other: >35 mg/dl]

22
Q

Lactate dehydrogenase

A

Supports meningitis diagnosis
- LD 4, 5 in granulocytes = bacterial
- LD 2, 3 in lymphs = viral

23
Q

Microbiological examination

A

gram stain, or acid fast
culture, always blood culture

  • use sediment for smears and cultures
24
Q

Cells in CSF amount with age

A

Decreases with age
Younger = more cells in CSF

25
Q

Lymphs to monos ratio

A

70:30

26
Q

WBC reference range %s

adult vs infants

A

Adults: 30-96% lymphs, 15-56% monos, 0-7% PMNs

Infants: higher monos, lower lymphs

27
Q

Normal cells in CSF

A

Lymphs: dominating
- Increased: non bacterial infections, listeria, degenerative

Monos: not dominating

28
Q

Macrophages in CSF

A

Not normal
- Hemorrhage or bleed, inclusions

< 12 hrs: RBCs, PMNs, lymphs, monos, macros

12-48 hrs: lymphs, macros, erythrophages

2-4 days: erythrophages, vacuolated macros, siderophages

1-8 weeks: siderophages, macrophages w/ hematin

29
Q

Other cells in CSF

A

Lining cells
- Ependymal
- Choroid plexus
- PAM cells

More likely in kids, abnormal # after surgery, trauma

Bone marrow cells
Chondrocytes cartilage from vertebral disk
NRBCs, SECs

30
Q

Bacterial vs viral meningitis

glucose, lactate, cell count, wbcs

A

Bacterial
- decreased <0.60 glucose
- increased >35 mg/dl lactate
- very increased >50,000/ul
- PMNs dominate

Viral
- normal to decreased glucose
- slight increase lactate 23-30 mg/dl
- increased but <50,000/ul cells
- lymphs dominate

31
Q

Multiple sclerosis

A

Increased CSF IgG index
Oligoclonal bands
Plasma cells

Microscopy (14 decks)

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