Cerebrospinal Fluid

Question 1

Definition

Answer 1

Fluid that occupies spaces of the CNS
Surrounds the brain and spinal cord

Question 2

Meninges

Answer 2

Layers of the brain

Question 3

Membranes covering Brain and Spinal Cord

Answer 3

Dura Mater
Leptomeninges

Question 4

Dura mater

Answer 4

Outside layer

Question 5

Leptomeninges

Answer 5

Arachnoid mater
Pia mater

Question 6

Arachnoid mater

Answer 6

Between the Dura mater and Pia mater
Considered to be part of the Leptomeninges

Question 7

Pia mater

Answer 7

Inner most membrane
Considered to be part of the Leptomeninges

Question 8

Primary production of CSF

Answer 8

Choroid plexus

Question 9

Mechanism of production

Answer 9

Filtration under hydrostatic pressure
Modified by active transport and selective absorption

Question 10

Rate of CSF production

Answer 10

Approximately 0.35 ml/min or 21 ml/hr

Question 11

Total Adult Volume of CSF

Answer 11

140-170 mL

Question 12

Total Neonate Volume of CSF

Answer 12

10-60 mL

Question 13

Percentage of turnover CSF

Answer 13

14% per hour
Reabsorption through ventricle

Question 14

CSF Function

Answer 14

Supplies nutrients
Removes waste
Blood/Brain barrier
Cushions and Lubricates

Question 15

CSF Collection

Answer 15

Lumbar Puncture or Spinal Tap
Between 3rd and 4th or 4th and 5th Lumbar vertebrae

Question 16

CSF Tubes in specific order

Answer 16

1 - Chemistry/serology
2 - Microbiology (never uses first tube due to poss contam)
3 - Hematology
4 - Hematology (if possible to obtain 4 tubes)

Question 17

Intracranial pressure monitored

Answer 17

Prevents damage to neural tissue
Determine safe amount of fluid to remove
Reflection of size of CSF reservoir
Indication of disease

Question 18

CSF Analysis Time Frame

Answer 18

Always considered a STAT sample
- Due to less friendly environment for cells
- Cells degrade quickly with no nutrients
Must be processed within 45 minutes

Question 19

Quality Control for CSF

Answer 19

Daily Counts
Monitor diluent for contamination
Monitor centrifuge speed and timer

Question 20

Appearance of typical CSF

Answer 20

Color - colorless
Clarity - clear

Question 21

Normal TNC Count

Answer 21

0-5/cumm
100% mononuclear (lymphs and monocytes)

Question 22

Normal RBC Count

Answer 22

0/cumm

Question 23

Normal Glucose level

Answer 23

2/3 of plasma glucose
(bacterial infections cause glucose to decreased)

Question 24

Normal Protein level

Answer 24

15-45 mg/dL
(could increase due to blood or meningitis)

Question 25

Other chemical analysis

Answer 25

Lactate, Glutamine, Enzyme

Question 26

Lactate increase

Answer 26

in bacterial meningitis

Question 27

Glutamine increase

Answer 27

Liver disease

Question 28

Two reasons for Bloody, pink, red

Answer 28

Hemorrhage Traumatic Tap

Question 29

Hemorrhage

Answer 29

Xanthochromic supernatant (red color) Blood amount consistent between tubes 1 and 3 - long term bleed - supernatant will have a yellowish/reddish hue

Question 30

Traumatic Tap

Answer 30

Capillary hit on insertion of needle Clear supernatant Blood amount decreasing between tubes 1 and 3 - Clots may be seen

Question 31

CSF Hazy or Cloudy

Answer 31

Increased number of cells Increased protein X-ray contrast media Microorganisms

Question 32

CSF Increased RBCs

Answer 32

Hemorrhage CVA/Stroke Traumatic Tap Bone Marrow Contamination

Question 33

Neutrophils increased in CSF

Answer 33

Bacterial meningitis (only report bacteria present) Early viral meningitis Hemorrhage Contamination

Question 34

nRBCs increased in CSF

Answer 34

Hemorrhage Contamination (Bone Marrow or Blood)

Question 35

Lymphocytes increased in CSF

Answer 35

Viral meningitis TB, fungal infection Multiple sclerosis

Question 36

Monocytes increased in CSF

Answer 36

Inflammation Clean up Post Hemorrhage TB

Question 37

Eosinophils increased in CSF

Answer 37

Parasitic infection Hydrocephalic Shunts CNS Eosinophilic Leukemia (VERY RARE)

Question 38

Blasts present in CSF

Answer 38

CNS involvement of Leukemia

Question 39

Other Malignant Cells Present

Answer 39

Metastatic Solid Tumors Lymphoma

Question 40

Macrophages Present

Answer 40

Clean up cells Post hemorrhage TB

Question 41

Plasma Cells

Answer 41

Lymphocytic Reaction Multiple sclerosis Multiple myeloma

Question 42

Other cells Present

Answer 42

Choroidal Cells Ependymal Cells Pia Arachnoid Cells

Question 43

Increased Glucose levels

Answer 43

Hyperglycemia or glucose loading

Question 44

Decreased Glucose levels

Answer 44

Disorder of glucose transport Metabolism of glucose by organisms or cells Glucose consumption by tumor or abcess

Question 45

Increased Protein levels

Answer 45

Most useful indicator Lysis of contaminant blood Infection and/or bleeding Increased production of protein Obstruction Decreased removal of protein

Question 46

Decreased Protein levels

Answer 46

Result of lumbar puncture CNS Leakage Increased removal of protein