CSF Flashcards
1
Q
3rd major body fluid
A
CSF
2
Q
Functions of CSF
A
Supply nutrients to nervous system, remove metabolic waste, cushion brain and spinal cord
3
Q
Meninges 3 layers
A
Dura mater, Arachnoid mater, Pia mater
4
Q
Outer layer of meninges
A
Dura mater
5
Q
Filamentous inner membrane
A
Arachnoid mater
6
Q
CSF flow space
A
Subarachnoid space
7
Q
Innermost meninges layer
A
Pia mater
8
Q
Reabsorption of CSF
A
Arachnoid villi
9
Q
CSF production and reabsorption rate
A
20 mL/hr
10
Q
CSF production site
A
Choroid plexus
11
Q
Protects brain from harmful substances
A
Blood-brain barrier
12
Q
CSF collection volume with manometer
A
20 mL
13
Q
Normal CSF pressure
A
50-180 mmHg
14
Q
CSF collection volume for high/low pressure
A
1-2 mL
15
Q
CSF collection method
A
Lumbar puncture (L3-L4 adults)
16
Q
CSF collection site in infants
A
L4-L5
17
Q
CSF Tube 1 storage
A
Freezing temp for chemistry/serology
18
Q
CSF Tube 2 storage
A
Room temp for microbiology
19
Q
CSF Tube 3 storage
A
Ref temp for hematology
20
Q
CSF Tube 4 use
A
Microbiology/Serology
21
Q
Least affected tube by contamination
A
Tube 1
22
Q
Tube for additional testing
A
Tube 4
23
Q
Excess CSF handling
A
Freeze until further testing
24
Q
Single CSF tube allocation priority
A
Micro > Hema > Chem/Sero
25
CSF total volume in adults
90-150 mL
26
CSF total volume in neonates
10-60 mL
27
Hazy/Milky/Turbid CSF indicates
Increased WBCs, RBCs, lipids, protein, microorganisms
28
Xanthochromic pink color
Slight oxyhemoglobin
29
Xanthochromic yellow color
Oxyhemoglobin to bilirubin
30
Xanthochromic orange color
Heavy hemolysis
31
Carotene, Melanin, Protein (>150 mg/dL), Rifampin causes what color in CSF
Xanthochromic
32
Bloody appearance of CSF is due to
RBCs (>6,000/uL), Traumatic tap, Intracranial hemorrhage
33
Indications of traumatic tap
Uneven blood distribution in tubes, Clot formation, Clear supernatant
34
Indications of intracranial hemorrhage
Even blood distribution, Xanthochromic, Erythrophage (hematoidin and hemosiderin), Positive D-dimer
35
Clinical significance of oily CSF
Radiographic contrast media
36
Clinical significance of clotted CSF
Protein, Clotting factors, Meningitis, Froin syndrome, CSF circulation blockage
37
Pellicle appearance in CSF
Tubercular meningitis
38
CSF cell count timing
Immediately or within 1 hour at room temperature
39
Percentage of WBCs disintegrating within 1 hour
0.4
40
Normal WBC count in adult CSF
0-5 WBCs/uL
41
Normal WBC count in neonate CSF
0-30 WBCs/uL
42
CSF dilution for clear fluid
Undiluted
43
CSF dilution for slightly hazy fluid
0.04861111111111116
44
CSF dilution for hazy fluid
0.05555555555555558
45
CSF dilution for slightly cloudy fluid
1:100
46
CSF dilution for cloudy/slightly bloody fluid
1:200
47
CSF dilution for bloody/turbid fluid
1:10,000
48
Formula for CSF WBC count
#cells counted x dilution/area x depth (0.1)
49
CSF diluting fluid
3% acetic acid with methylene blue
50
Cleaning nondisposable chamber for CSF counting
Soak in bactericidal solution 15 mins; rinse with water; clean with isopropyl alcohol
51
WBC correction for every 700 RBCs
Subtract 1 WBC
52
Total protein correction for every 10,000 RBCs/uL
Subtract 8 mg/dL
53
Total protein correction for every 1,200 RBCs/uL
Subtract 1 mg/dL
54
CSF smear preparation
Concentrate specimen before smearing
55
Methods for CSF differential count
Cytocentrifugation, Centrifugation, Sedimentation, Filtration
56
Monolayer cell diameter during CSF cytocentrifuge
6 mm
57
CSF additive for cell yield/recovery
30% albumin
58
Predominant cells in CSF
Lymphocytes and monocytes
59
Adult lymphocyte-to-monocyte ratio in CSF
70% lymph, 30% mono
60
Neonate cell ratio in CSF
80% monocytes, 20% lymphocytes
61
Increased number of normal cells in CSF
Pleocytosis
62
Significance of lymphocytes and monocytes in CSF
Normal, Viral/TB/Fungal meningitis, Multiple sclerosis
63
Significance of neutrophils in CSF
Bacterial meningitis, Early viral/TB/fungal meningitis, Cerebral hemorrhage
64
Significance of eosinophils in CSF
Parasitic/fungal infections, Coccidioidal meningitis, Medications, Shunts
65
Significance of macrophages in CSF
RBCs in spinal fluid, Contrast media
66
Blast forms in CSF indicates
Acute leukemia
67
Plasma cells in CSF clinical significance
Multiple sclerosis
68
Ependymal, choroidal, spindle-shaped cells clinical significance for CSF
Diagnostic contamination
69
Malignant cells in CSF indicates
Carcinoma or leukemia
70
Normal values of CSF protein in adults
15-45 mg/dL
71
Normal values of CSF protein in infants
<150 mg/dL
72
Normal values of CSF protein in immature
<500 mg/dL
73
Protein is increased in CSF during
Meningitis, hemorrhage, trauma, multiple sclerosis
74
Decreased protein in CSF indicates
Increased CSF flow or leakage
75
Major CSF protein
Albumin
76
Second most prevalent protein in CSF
Prealbumin
77
Alpha-globulins in CSF
Haptoglobin, ceruloplasmin
78
Beta-globulins in CSF
Transferrin
79
Gamma-globulin in CSF
IgG
80
Not normally found in CSF
Fibrinogen
81
Preferred method for CSF total protein
Turbidimetric (Coomassie Brilliant Blue)
82
To precipitate globulins, add
Ammonium sulfate
83
Coomassie Brilliant Blue positive reaction indicates
Protein presence
84
CSF/Serum albumin index is used for
Assessing blood-brain barrier integrity
85
CSF/Serum albumin index formula
CSF albumin (mg/dL) / Serum albumin (g/dL)
86
Normal value of CSF/Serum albumin index
<9
87
CSF/Serum albumin index: 9-14
Mild impairment
88
CSF/Serum albumin index: 15-100
Moderate impairment
89
CSF/Serum albumin index: >100
Severe impairment
90
CSF/Serum albumin index: Complete damage to BBB
>100
91
IgG index is used for CSF
Detecting IgG production within CNS
92
Normal value of IgG index
0.3-0.7
93
Abnormal IgG index
>0.7
94
Detection of oligoclonal bands in gamma region indicates
Immunoglobulin production
95
Valuable for the diagnosis of Multiple Sclerosis
CSF electrophoresis
96
Better resolution in CSF electrophoresis is obtained using
Immunofixation or isoelectric focusing
97
Oligoclonal banding in CSF but NOT in serum
Multiple sclerosis
98
Oligoclonal banding in serum but NOT in CSF
Systemic infection or inflammation
99
Oligoclonal banding in both serum and CSF
CNS infection
100
Protein component of lipid-protein complex insulating nerve fibers
Myelin basic protein (MBP)
101
Presence of MBP in CSF indicates
Destruction of myelin sheath, Multiple sclerosis
102
Method for MBP detection
Immunoassay
103
Demyelinating disorder findings
Increased MBP, IgG index, oligoclonal bands
104
Specimen for blood glucose should be drawn
Simultaneously with CSF sample
105
Normal values of CSF glucose
50-80 mg/dL or 60-70% of plasma glucose
106
Decreased CSF glucose is seen in
Bacterial, fungal, or tubercular meningitis
107
Viral meningitis plasma glucose and CSF lactate levels
Normal glucose, lactate <25 mg/dL
108
CSF lactate is ___ to glucose
Independent
109
Sensitive method for evaluating antibiotic therapy
CSF lactate measurement
110
Normal values of CSF lactate
10-22 mg/dL
111
Increased CSF lactate is seen in
Bacterial, fungal, tubercular meningitis, cerebral ischemia
112
Product of ammonia and alpha-ketoglutarate
Glutamine
113
Normal value of CSF glutamine
8-18 mg/dL
114
Indirect test for excess ammonia in CSF
Glutamine measurement
115
Increased CSF glutamine is seen in
Reye syndrome, hepatic encephalopathy
116
CSF enzymes
LDH, AST, ALT, CK
117
LDH isoenzymes in CSF
LDH1 and LDH2
118
CSF LDH pattern for bacterial meningitis
Increased LDH1 and LDH2
119
CSF detection of bacterial antigens
Latex agglutination, immunoassays
120
Recommended by CDC for neurosyphilis detection
VDRL test
121
Predominant WBC in bacterial meningitis
Neutrophils
122
Protein and lactate increased in CSF indicates
Bacterial or fungal meningitis
123
Predominant cells in viral meningitis
Lymphocytes
124
Increased protein in CSF indicates
Bacterial, fungal, tubercular meningitis
125
Tubercular and fungal meningitis predominant WBC in CSF
Lymphocytes and monocytes
126
Classic starburst pattern in CSF
Cryptococcus neoformans
127
Agents of viral meningitis
Enterovirus, Herpes simplex, Mumps virus
128
Detection of Gram-negative endotoxin in fluids/instruments
Limulus amoebocyte lysate test
129
Reagent for Limulus amoebocyte lysate
Amebocyte extract
130
Principle of Limulus amoebocyte lysate
Gel-clot formation in presence of endotoxin
