CEREBROSPINAL FLUID Flashcards
(144 cards)
1
Q
1st recognized by
A
Cotugno (1764)
2
Q
3rd MAJOR FLUID IN THE BODY
A
CSF
3
Q
produced in the [?] and serves several functions
A
brain
4
Q
serves as a protective fluid, cushioning and lubricating the brain and spinal column.
A
CSF
5
Q
The brain and spinal cord are enclosed in three layers of membrane, the meninges:
A
DURA MATER
ARACHNOID MATER/ARACHOIDEA
PIA MATER
6
Q
”hard mother”- Outermost membrane
A
DURA MATER
7
Q
”spider-web-like”- Middle
A
ARACHNOID MATER/ARACHOIDEA
8
Q
”gentle mother”- Innermost layer and adheres to the surface of neural tissue.
A
PIA MATER
9
Q
Produced by
A
CHOROID PLEXUSES
10
Q
flows through
A
SUBARACHNOID SPACE
11
Q
reabsorbed by
A
ARACHNOID VILLI/GRANULATION
12
Q
VOLUME:
A
20mL/hour
Adults: 140-170ml
Neonates: 10-60ml
13
Q
used to represent the control and filtration of blood components to the CSF and to the brain
A
BLOOD-BRAIN BARRIER(BBB)
14
Q
SPECIMEN COLLECTION AND HANDLING SITES
ADULTS:
A
Between 3rd and 4th (or lower) lumbar vertebrae
15
Q
SPECIMEN COLLECTION AND HANDLING SITES
CHILDREN:
A
Between 4th and 5th lumbar verebrae
16
Q
most common position
A
LUMBAR PUNCTURE (fetal position/Lateral Decubitus Position)
17
Q
: sub-occipital region
A
Cisternal Puncture
18
Q
: infants with open fontanels
A
Ventricular Puncture
19
Q
collection positions
A
LUMBAR PUNCTURE (fetal position/Lateral Decubitus Position)
Cisternal Puncture
Ventricular Puncture
Lateral cervical puncture
20
Q
Chemical & serological tests
A
1
21
Q
Frozen at -15 to -30oC
A
1
22
Q
Microbiological tests
A
2
23
Q
Room Temp at 19 to 26 oC
A
2
24
Q
Cell count /Hematology
A
3
25
Refrigerated at 2 to 8 oC
3
26
Microbiology /chemistry/serology
4
27
LOW-VOLUME Specimens –
Microbiology > Hematology > Chemistry/Serology
28
STAT basis (WITHIN [?])
30 MINUTES
29
—most frequently performed chemical test on CSF
Protein
30
Protein Normal values:
6 months to adults =
Newborn =
> 60 y/o =
15 to 45 mg/dl
75 to 150 mg/dl
>60 mg/dl
31
ALBUMIN > PREALBUMIN > HAPTOGLOBIN AND CERULOPLASMIN > TRANSFERRIN
32
DECREASED IN PROTEINS
Leakage fluid in CNS
Recent puncture
Water intoxication
Rapid CSF production
33
QUALITATIVE TESTS
NONNE-APELT
ROSE JONES
PANDY’S
NOGOCHI
34
NONNE-APELT
Reagent:
Product:
Ammonium sulfate
Cloudy precipitate
35
ROSE JONES
Reagent:
Product:
Ammonium sulfate
White ring
36
PANDY’S
Reagent:
Product:
Phenol
Bluish white cloud
37
NOGOCHI
Reagent:
Product:
10% Butyric acid
Precipitate
38
QUANITATIVE TESTS
1. TURBIDIMETRIC
2. DYE-BINDING TECHNIQUES
3. NEPHELOMETRY
4. ELECTROPHORESIS
39
1. TURBIDIMETRIC REAGENTS
TRICHLOROACETIC ACID(TCA)
SULFOSALICYLIC ACID(SSA)
40
2. DYE-BINDING TECHNIQUES REAGENTS
COOMASSIE BRILLIANT BLUE(CBB) G250
PONCEAU S
41
3. NEPHELOMETRY REAGENTS
Benzalkonium chloride
42
4. ELECTROPHORESIS
43
“Protein Error of indicators”
DYE-BINDING TECHNIQUES
44
Most frequently performed
ELECTROPHORESIS
45
Method of choice for the determination of CSF
ELECTROPHORESIS
46
Detection of OLIGOCLONAL BANDS
ELECTROPHORESIS
47
MULTIPLE SCLEROSIS
ELECTROPHORESIS
48
Encephalitis, neurosyphilis, Guillain-Barre Syndrome and Neoplastic Disorders
ELECTROPHORESIS
49
:
- comparison between serum and CSF levels of albumin and IgG must be made
PROTEIN FRACTIONS
50
Evaluates BBB integrity
CSF-Serum Albumin Index
51
Determines IgG production within the CNS
CSF-Serum IgG Index
52
CSF-Serum Albumin Index Index Value
< 9: intact BBB
>9: damaged BBB
53
CSF-Serum IgG Index Value
> 0.77: IgG production within the CNS
54
Cerebrospinal Fluid Glucose
NORMAL VALUE:
Neonates:
60-70%
80%
55
Cerebrospinal Fluid Glucose INCREASED IN:
Plasma glucose elevation
DM
Encephalitis and conditions associated with intracranial pressure
56
Cerebrospinal Fluid Glucose DECREASED IN:
Aids in determining the causative agent of
meningitis
57
GLUCOSE CONCENTRATION IN BACTERIAL
DECREASED
58
GLUCOSE CONCENTRATION IN TUBERCULAR
DECREASED
59
GLUCOSE CONCENTRATION IN VIRAL
NORMAL
60
GLUCOSE CONCENTRATION IN FUNGAL
NORMAL OR DECREASED
61
INCREASED NEUTROPHILS
BACTERIAL
62
INCREASED LYMPHOCYTES
TUBERCULAR AND VIRAL
63
+ INDIA INK(C.neoformans)
FUNGAL
64
Aids in the diagnosis and management of meningitis
Cerebrospinal Fluid Lactate
65
Used to evaluate effectiveness of antibiotic therapy
66
Used to monitor severe head injuries
Cerebrospinal Fluid Lactate
67
< 25 mg/dL:
VIRAL MENINGITIS
68
> 25 mg/dL:
TUBERCULAR AND FUNGAL MENINGITIS
69
> 35mg/dL:
BACTERIAL MENINGITIS
70
Cerebrospinal Fluid Glutamine
NORMAL VALUE:
8-18mg/dL
71
Frequently performed in CSF but not in blood
Cerebrospinal Fluid Glutamine
72
INDIRECT measure of CSF AMMONIA
Cerebrospinal Fluid Glutamine
73
Aids in the diagnosis of meningitis
Cerebrospinal Fluid LD Isoenzymes
74
LD1 and LD2 :
brain tissue destruction
75
LD2 and LD3 :
viral meningitis
76
LD4 and LD5 :
bacterial meningitis
77
CK-BB
>17mg/dL
<17mg/dL
78
WBC: COUNT:
routinely perfomed
79
RBC COUNT:
traumatic tap and correction for leukocytes or proteins
80
RBC count=
Total Cell count-WBC count
81
TOTAL CELL COUNT:
hemocytometer
82
Diluent:
Normal saline solution(NSS)
83
Disturbance in consciousness (>35mg/dl)
Glutamine
84
Coma of unknown origin (results from ↑ usage of α-ketoglutarate)
Glutamine
85
Reye’s syndrome (75% of diagnosed children)
Glutamine
86
in post-cardiac arrest indicates poor prognosis
CK-BB Isoenzyme >17mg/dL
87
indicates recovery from cardiac arrest after resuscitation
CK-BB Isoenzyme <17mg/dL
88
predominant in adults
Lymphocytes
89
lymphocyte to monocyte ratio
70:30
90
predominant in children
monocytes
91
lymphocyte to monocyte ratio
30:70
92
: rare normal cell component
neutrophils
93
: ↑numbers of normal cells (abnormal finding)
Pleocytosis
94
Abnormal CSF Cells:
immature WBCs, eosinophils, plasma cells, macrophages, increased tissue cells and malignant cells
95
Performed when there is: (1) traumatic tap, (2) a need for leukocyte correction, and (3) a need for protein correction
RBC Count
96
𝑹𝑩𝑪 𝑪𝒐𝒖𝒏𝒕 =
𝑹𝑩𝑪 𝑪𝒐𝒖𝒏𝒕 = 𝑻𝒐𝒕𝒂𝒍 𝑪𝒆𝒍𝒍 𝑪𝒐𝒖𝒏𝒕 − 𝑾𝑩𝑪 𝑪𝒐𝒖𝒏𝒕
97
Total Cell Count
Cells are counted in the four corner squares and the center square of the [?]
[?] is used to load the hemocytometer
Diluent: [?]
Improved Neubauer hemocytometer
Pasteur pipet
Normal Saline Solution (NSS)
98
𝑪𝒆𝒍𝒍𝒔/𝒖𝑳 =
99
Dilution
20
100
Sample is undiluted and examined using a phase-contrast microscope
Fuchs-Rosenthal Counting Chamber
101
With 16 large squares and 0.2 mm depth
Fuchs-Rosenthal Counting Chamber
102
Fuchs-Rosenthal Counting Chamber Cells Formula
Number of cells/3
103
Specimens are concentrated and stained
Differential Count
104
Number of cells counted: 100
<100 cells: report # of cells counted
Differential Count
105
Performed to identify the causative agent in meningitis
MICROBIOLOGIC EXAMINATION
106
MICROBIOLOGIC EXAMINATION SPECIMEN:
CSF and blood
107
MICROBIOLOGIC EXAMINATION
Specimens should be concentrated by centrifugation at
1500xg for 15 minutes
108
Microorganism must be recovered from CSF by growing it on appropriate culture medium for positive identification
Blood Culture
109
Medium for culture
Thioglycholate broth and Chocolate agar
110
Blood Culture Duration of incubation:
bacterial meningitis
tubercular meningitis
24 hours
6 weeks
111
Confirmatory procedure rather than diagnostic
Blood Culture
112
Cultures are to what percentage sensitive
80% to 90%
113
Gram Staining is to what percentage sensitive
60% to 90%
114
Microorganism must be recoverd from CSF by growing appropriate [?] for identification
culture medium
115
Routinely performed on CSF from all suspected cases of meningitis
Gram Staining
116
Recommended method for the detection of organisms
Gram Staining
117
of organism should be present for adequate Gram stain results
100,000/ml
118
Organisms most frequently observed:
Gram (+):
Gram (-):
Star burst pattern:
Streptococcus pneumoniae (cocci) Streptococcus agalactiae (cocci) in newborns Listeria monocytogenes (bacilli) in newborns
Escherichia coli (bacilli) Neisseria meningitides (cocci) Haemophilus influenza (pleomorphic bacilli)
Cryptococcus neoformans
119
Performed when tubercular meningitis is suspected
Acid Fast/Fluorescent Antibody Stains
120
Positive report is extremely valuable
Acid Fast/Fluorescent Antibody Stains
121
Detect the presence of a thickly encapsulated Cryptococcus neoformans
India Ink
122
More sensitive method in the detection Cryptococcus neoformans in serum and CSF
Reverse Latex Agglutination
123
Should be confirmed by culture and India ink
Reverse Latex Agglutination
124
False positive reactions occur mainly due to rheumatoid factor
Reverse Latex Agglutination
125
Used in combination with hematology and clinical chemistry results
Bacterial Antigen Test
126
Provide rapid means for detecting and identifying microorganisms in CSF
Latex Agglutination Tests and ELISA
127
Test kits available for the detection of Streptococcus group B, Haemophilus influenzae type B, Streptococcus pneumoniae, Neisseria meningitidis A, B, C, Y, W135, and Escherichia coli K1 antigens.
Latex Agglutination Tests and ELISA
128
Diagnosis of meningitis caused by Gram (-) organisms
Limulus Lysate Test
129
Principle: The endotoxin produced by the cell walls of Gram (-) organisms will coagulate the amebocyte lysate within 1 hour incubated at 37oC.
Limulus Lysate Test
130
Reagent: Blood cells (amebocyte) of horseshoe crabs (Limulus polyphemus)
blue in color due to the presence of a copper complex
Limulus Lysate Test
131
Performed for the diagnosis of neurosyphilis
Venereal Disease Research Laboratories (VDRL)
132
Most sensitive and specific for syphilis diagnosis
Fluorescent Treponemal AntibodyAbsorption (FTA-ABS)
133
Confirmatory test for meningitis
Culture
134
Causative agent of primary meningoencephalitis
Naegleria fowleri
135
Seen in wet preparations
Motile trophozoite
136
Cytocentrifuged
Non-motile trophozoite
137
Specimens accompanied by increased wbc but no bacteria
Non-motile trophozoite
138
Crystal clear
Normal
139
Hazy, turbid, milky, cloudy
WBCs Microorganisms Protein
140
Oily
Radiographic contrast media
141
Bloody
RBCs
142
Xanthochromic
Hemoglobin Bilirubin Carotene Protein Melanin
143
Clotted
Protein Clotting factors
144
Pellicle
Protein Clotting factors
