CSF Flashcards
1
Q
A membranous three-layer coverings of brain and spinal cord.
A
Meninges
2
Q
The third major body fluid.
A
CSF
3
Q
Give three functions of CSF.
A
- Supply nutrients to the nervous system.
- Remove metabolic wastes.
- Produce a mechanical barrier to cushion the brain and spinal cord against trauma.
4
Q
What are the three layers of meninges?
A
Dura Mater
Arachnoid Mater
Pia Mater
5
Q
Tough mother, outermost layer
A
Dura Mater
6
Q
Tender mother, innermost layer
A
Pia Mater
7
Q
Spider-like, filamentous inner membrane
A
Arachnoid Mater
8
Q
trabeculae are found in this space, which is filled with circulating CSF
A
subarachnoid space
9
Q
where csf flows
A
subarachnoid space
10
Q
composed of tight junctions of endothelial cells which makes up BBB
A
choroid plexus
11
Q
What is the rate of production of choroid plexus?
A
20ml/hr
(500 ml/day; 0.3-0.4 ml/min)
12
Q
prevents passage of many molecules
A
blood brain barrier
13
Q
protects brain from toxins, infections, or other substances
A
blood brain barrier
14
Q
it reabsorbs circulating CSF back to peripheral circulation
A
Arachnoid villi / granulations
15
Q
What is the rate of reabsorption rate of arachnoid villi?
A
20 ml/hr
16
Q
true / false
Rate of production = Rate of absorption
A
T
17
Q
Two method of CSF collection.
A
Lumbar puncture / Spinal tap
Cisternal puncture
18
Q
Puncture directly below occipital bone
A
Cisternal puncture
19
Q
A procedure where needle is inserted into the lumbar subarachnoid space to collect cerebrospinal fluid (CSF) for laboratory testing,
A
Spinal tap / lumbar puncture
20
Q
what are the vertebral location for spinal tap?
A
between the 3rd and 4th or the 4th and 5th lumbar vertebrae
21
Q
How much CSF is collected in a patient?
A
20 ml
22
Q
How many tubes are usually required for CSF collection?
A
Aseptically collected CSF fluid in 3 or 4 sterile tubes.
23
Q
Which tube and section is stored at room temp?
A
Tube 2 - Micro
24
Q
Which tube is for hema section? what temp?
A
Tube 3 - ref temp
25
4th tube for CSF collection is for ?
Optional
Micro - RT
Chem/Sero - Frozen
26
The first tube for CSF collection is for what section and temp?
Chem/ Sero - frozen
27
ONLY 1 tube of CSF was collected. What is our priority?
1) MICRO
2) hema
3) chem/sero
28
CSF volume of adults
90-150ml
29
Why is the 1st tube for chem/sero?
because chem/sero is least affected by blood or bacteria introduced during CSF collection
30
why is that the 2nd tube is for microbio?
bec it’s no longer at risk of bacteria/skin contamination due to csf collection
31
The 3rd tube is for HEMA section. Yes or No? and Why?
Yes, bec it least likely to contain skin cells after spinal tap.
32
CSF collection for neonates.
10-60ml
33
What is likely the cause of a hazy/turbid/milky/cloudy csf?
wbcs >200ul
rbcs >400ul
microorganisms
proteins
lipids
34
What is the most likely cause of a hazy/turbid/milky/cloudy csf?
wbcs >200ul
rbcs >400ul
microorganisms
proteins
lipids
35
What is the normal csf appearance?
Crystal clear
36
An abnormal discoloration of csf
Xanthochromia
37
a yellow csf appearance could be because of ?
1) degradation of oxyhgb to bilirubin
2) increased protein (>150mg/dl)
3) anti-septic contamination with iodine
xanthochromia
38
a pink csf appearance might be because of ?
the slight amt of oxyhgb
xanthochromia
39
an orange csf appearance might mean ?
1) Heavy hemolysis
2) hypervitaminosis A - presence of carotene
xanthochromia
40
an oily csf appearance
Radiographic contrast media
41
a csf is stored overnight inside ref, it formed an appearance of ?
pellicle - weblike
42
clinical significance of csf pellicle appearance
turbercular meningitis
43
a xanthochromia of csf giving red-orange color might be because of?
Rifampicin
44
a bloody csf appearance could mean that rbcs are?
Increased rbcs >6,000/ul
45
traumatic tap:
Distribution of blood
Clot formation
Supernatant
Erythrophages
D-dimer
Distribution of blood 1>2>3
Clot formation (+)
Supernatant - clear
Erythrophages (-)
D-dimer (-)
46
Intracranial Hemorrhage:
Distribution of blood
Clot formation
Supernatant
Erythrophages
D-dimer
Distribution of blood 1=2=3
Clot formation (-)
Supernatant - xanthochromic
Erythrophages (+); presence of hemosiderin and hematoidin crystals
D-dimer (+)
47
What are the clinical significance of a clotted CSF appearance?
Meningitis, FROIN SYNDROME (hypercoagulability xanthochromia, inc. protein), blockage of CSF circulation, traumatic tap
48
any csf cell count must be performed later.
IMMEDIATELY
49
What will happen to wbc and rbc within an hour after collection?
Lyse
50
What is the percentage of wbcs that will disintegrate within 2hrs
40%
51
t/f
rbcs are routinely performed on csf
F
52
What is the diluting fluid for wbc count?
3% acetic acid with methylene blue
53
T/F
3% acetic acid with methylene blue lyses wbc and stain.
F, rbc
54
For every 700 rbcs, subtract 1 wbc. For every 10,000 rbcs/ul, subract 10mg/dl in total protein conc.
T/F
F, subtract 8 for every 10k
55
Clinical significance of viscous csf.
Metastatic mucin-producing adenocarcinoma
Cryptococcal meningitis – polysaccharide (contributes to viscosity)
Liquid nucleus pulposus
56
csf diff ct is done on stained csf smear, csf should be concentrated first before preparing smear.
T/F
T
57
Clinical Significance: Ependymal, Choroidal, & Spindle-shaped cells
Diagnostic procedures - neurosurgery, pneumoencephalography
58
Clinical significance: blast forms
Acute leukemia
59
Clinical significance: macrophages
Intracranial hemorrhage
60
Clinical significance: lymphoma cells
Disseminated lymphoma
61
Clinical significance: plasma cells
Multiple sclerosis, lymphocyte reactions
62
Clinical significance: neutrophils
Bacterial meningitis
Early case of viral, tubercular, & fungal meningitis
Cerebral hemorrhage
63
What is Pleocytosis?
increased number of normal cells (mono, lympho) in CSF
64
Normal ratio of lymphocytes and monocytes on csf of adults and newborns.
Adults = 70% L : 30% M
NB = 30% L : 70% M
65
Clinical significance: malignant cells
Metastatic carcinoma, primary CNS carcinoma
66
Major protein in CSF
Albumin
67
2nd most prevalents csf protein
Pre-albumin
68
Clinical significance: monocytes and lymphocytes
Viral tubercular, fungal meningitis, Multiple sclerosis
69
carbohydrate-deficient transferrin, ONLY present in CSF
TAU
70
collect blood glucose 5hrs before spinal tap.
False. 2hrs before dapat.
71
What is the preferred method for CSF TOTAL protein determination - turbidimetric?
TRICHLOROACETIC ACID (TCA) - 30% TCA
72
Preferred method for CSF total protein determination, it precipitates both ____ & ______ .
TRICHLOROACETIC ACID (TCA) - 30% TCA, both albumin and
globulin
73
What is the method for CSF TOTAL protein determination - turbidimetric that precipitates ONLY the ALBUMIN?
SULFOSALICYLIC ACID (SSA) - 3% SSA
74
what should you add to precipitate globulins in 3% SSA?
Ppt globulins = add Na2SO4
75
assesses conditions that results to IgG production within CSF
Ex. MS
IgG index
76
Detection of OLIGOCLONAL BANDS IN GAMMA REGION
CSF electrophoresis
77
CSF total protein determination- dye binding: Protein binds to dye then dye turns from RED to BLUE
COOMASIE BRILLIANT BLUE
78
Enumerate those with the presence of 2 oligoclonal bands in CSF but not in serum
1. MS–persistent cause
2. Neurosyphilis
3. Encephalitis
4. Neoplastic disorder
5. Guillain-barresyndrome
79
what could be the cause of an intense blue color in csf protein determination?
Inc CHON
80
What are the two CSF protein fractions determination?
1) CSF Albumin (mg/dL) / SERUM ALBUMIN (g/dL) INDEX
2) IGG INDEX
81
A demyelinating disorder
MS
82
clinical significance of decreased csf glucose
Bacterial, tubercular, and fungal meningitis
Alterations in glucose transport across BBB
Increased used of glucose by brain cells
83
Clinical significance of increased csf glucose?
DM
84
CSF glucose and lactate is normal in ?
Viral meningitis
85
Clinical significance of increased csf lactate?
Bacterial meningitis (>35 mg/dL)
Tubercular & fungal meningitis (>25 mg/dl)
Hypoxia
86
A waste product of glucose metabolism
Lactate
87
Indirect test for presence of excess NH3 in CSF
CSF glutamate
88
Clinical significance of increased csf glutamate?
Disturbance of consciousness (>35 mg/dL)
Reye‟s Syndrome (75%)
89
Increased NH3 = increased glutamate
T/F
t
90
Normal pattern of CSF
1>2>3>4>5
91
Isoenzymes in CSF
◦ LD1&2:braintx
◦ LD 2 & 3: lymphocytes ◦ LD 4 & 5: neutrophils
92
what are csf enzymes?
LD, CK, AST
93
Common Agents:
1. Group B streptococci
(neonates)
2. E. coli & other gram-negative bacilli (NB-1mos)
3. Neisseria meningitidis
(>3mos)
4. Streptococcus pneumonia
(>3mos)
5. Haemophilus influenza
(3mos-18yrs)
6. Listeria monocytogenes
Bacterial meningitis
94
Agent: M. tuberculosis
Tubercular meningitis
95
Both causes granulomatous amoebic encephalitis
Acanthamoeba spp.
Balamuthia mandrillaris
96
Agent: C. neoformans
Fungal meningitis
97
Common agents of amoebic meningoencephalitis
1. Naegleria fowleri
2. Acanthamoeba spp.
3. Balamuthia mandrillaris
98
primary agent of amoebic meningoencephalitis
Naegleria fowleri
99
what are common agents of viral meningitis?
Enteroviruses
- Coxsackievirus
- Echovirus
- Poliovirus
Arbovirus
100
Gold standard of viral meningitis
RT-PCR
101
Reagent of limulus lysate test?
Blood of horseshoe crab
102
Detects gram negative (-) bacterial endotoxin body fluids & surgical instruments
Limulus lysate test
103
Causative agents of spirochetal meningitis?
Neurosyphilis – T. pallidum
Neuroborreliosis – B. burgdorferi
104
causative agent of neuroborreliosis?
B. burgdorferi
105
What color will show when using acridine orange in a csf sample of a patient with amoebic meningoencephalitis?
Brick red
106
T/F
A csf sample positive for tubercular meningitis shows positive AFP stain and a pellicle formation after 12-24hrs of storage in ref.
T
107
Diagnosis for spirochetal meningitis
1. Nontreponemal tests (VDRL, FTA-Abs)
2. ELISA
3. Western Blot
108
recommended by CDC to detect neurosyphilis
Nontreponemal tests - vdrl or fta-abs
109
Viral meningitis:
WBC & Protein
Glucose & Lacatate
Increased wbc, protein
Normal glucose, lactate
110
what pattern will show after (+) gram stain in a sample positive for fungal meningitis?
Starburst pattern
111
◌ Fluid is added to a conical chamber
◌ Cells are forced into a monolayer within a 6mm
diameter circle on the slide
◌ Addition of 30% ALBUMIN:
• Increases yield or recovery
• Decreased cellular distortion
Cytocentrifugation
112
Tubes for CSF fluid
CMHO
1. Chem / Sero - frozen
2. Micro - RT
3. Hema - ref temp
4. Optional - micro / chem/sero
113
Tubes for SEROUS fluid
ESHP
1. EDTA - cell/diff ct
2. Sterile Heparin - micro
3. Heparin - chem, other tests: sero
4. Plain - clotting test
114
Tubes for SYNOVIAL fluid
SALI NNA
1. SPS / Sterile Na Heparin - micro
2. LIQUID EDTA / Na Heparin - hema
3. Non-anti-coagulated - chem/sero
4. Na fluoride - glucose analysis
115
• Increased: stroke, MS, degenerative disorders, brain
tumors, viral & bacterial meningitis, epileptic seizure
CK
116
• Increased: intracerebral and subaracnoid hemorrhage,
bacterial meningitis
AST
