CSF Flashcards by skug LU

CSF FUNCTION

Physiologic system (function)
o Supply nutrients to the nervous tissue
o Remove metabolic wastes
o Maintains intracranial pressure
o Produce a mechanical barrier to cushion the brain and spinal cord against trauma (brain is suspended in CSF)

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Brain and spinal cord are lined by the

meninges

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Three layers of meninges

o Dura mater (Latin for “hard mother”) – outer layer that lines the skull and vertebral canal

o Arachnoid (“spiderweb-like”) – filamentous inner membrane; middle

o Pia mater (Latin for “gentle mother”) – thin membrane lining the surfaces of the brain and spinal cord

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WHERE IS CSF PRODUCED

in the choroid plexus of the lumbar ventricles and 3rd and 4th ventricle

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how much csf is made by adults

20 mL per hour produced in adults

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To maintain volume: CSF reabsorbed back into the blood
capillaries in the ____________(one-way
valves) at a rate equal to its production

arachnoid granulations/villae

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who does the selective filtration of csf

choroid plexus

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Very tight-fitting endothelial cells, prevent passage of
many molecules

Blood-brain barrier

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Disrupted/damaged BBB can cause

Disrupted/damaged BBB: Meningitis and
multiple sclerosis that allows leukocytes,
proteins, and other chemicals to enter the CSF

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(to measure opening pressure nung
ipupuncture sa spinal column)

Manometer`

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Collection site of csf

Adult: 3rd and 4th interlumbar space - Child: 4th and 5th interlumbar space

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how much csf sample is collected

1-2 ml of fluid is
collected in each of 3 containers (max of 6ml CSF is collected) since there are three tubes

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Samples: Three sterile tubes
what are their dept

o Tube 1: CHEMISTRY/SEROLOGY -
o Tube 2: MICROBIOLOGY
o Tube 3: HEMATOLOGY

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Test protein, sugar, lactic acid, glutamine,
enzymes, VDRL in chemistry and antibodies and
antigens in serology

Tube 1: C

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Gram stain, Acid fast stain, Indian ink, Culture

Tube 2:

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Total cell count and differential count

Tube 3:

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tub ethat is east affected by blood or bacteria introduced as
a result of the tap procedure

tube

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TEST must be done ASAP/ STAT (less than 1
hour), if you expect delay, freeze your sample
(stored in freezer)

Tube 1: CHEMISTRY/SEROLOGY

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TEST must be done ASAP/ STAT, if you expect
delay sample must be stored at room
temperature

Tube 2: MICROBIOLOGY

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failure to freeze smaple in tube can lead to

Fail to freeze → analytes concentration will drop

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Least likely to contain cells introduced by the
spinal tap proce-dure

o Tube 3: HEMATOLOGY

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Least contaminated with cells, blood, and bacteria

tube3

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EST must be done ASAP/ STAT, if you expect
delay, sample must be refrigerated (store
temporarily, maximum of 4 hours)

Tube 3: HEMATOLOGY

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tube used for o For better exclusion of skin contamination

tube 4

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* Crystal-clear = * Cloudy/turbid = i * Milky = * Hemolyzed/blood = * Xanthochromic or xanthochromia

* Crystal-clear = normal * Cloudy/turbid = indicative of infection; presence of WBC * Milky = increased protein or lipid concentration * Hemolyzed/blood = caused by RBCs * Xanthochromic or xanthochromia o Color will vary from: pink → orange → yellow

Pink

(very slight amount of oxyhemoglobin)

Orange (

(heavy hemolysis

Yellow

(conversion of oxyhemoglobin to unconjugated bilirubin)

Caused by the presence of RBC degradation (hemolysis) products

Xanthochromic or xanthochromia

(red orange)

Rifampicin or rifampin

brown

Melanoma

- Presence of the pigment carotene - Markedly increased protein concentrations

Xanthochromic or xanthochromia

when does cxantochromia show

Takes about 4-5 hours after hemorrhage

Associated with Tuberculosis with protein

Pellicle formation

o >1gm/dL o 24 hours refrigeration (sample is allowed to undergo refrigeration for 24 hrs)

increased fibrinogen

Clot formation – usually fibrinogen are increased during traumatic tap

appearance of csf Disorders affecting blood brain barrier

Hazy, turbid, milky, cloudy

Production of IgG within the CNS appearamnce

Hazy, turbid, milky, cloudy

due to Radiographic contrast media

oily

Old hemorrhage Lysed cells from traumatic tap

Xanthochromic - Hemoglobin

Tubercular meningitis

Pellicle

Indication of intracranial/cerebral hemorrhage

Bloody CSF

an differentiate hemorrhage and traumatic tap

Three visual (physical) examinations

Uneven blood distribution Clot formation Supernatant fluid is not xanthochromic vs Even distribution of blood No clot formation Xanthochromic supernatant Erythrophagocytosis and positive D-dimer

TRAUMATIC TAP COLLECTION CEREBRAL/INTRACRANIAL HEMORRHAGE

Erythrophagocytosis and positive D-dimer

CEREBRAL/INTRACRANIAL HEMORRHAGE

TRAUMATIC COLLECTION (TAP) first criteria

* First criteria: Blood distribution

Blood is evenly distributed in three CSF tubes (equal or uniform degree of color)

Cerebral hemorrhage

– uneven blood distribution

Traumatic tap

Performing can differentiate traumatic tap and cerebral hemorrhag

RBC count - Cerebral hemorrhage = constant RBC - Traumatic tap = decreasing

due to damaged blood-brain barrier that increase filtration of protein and coagulation factors

Non-bloody CSF

Conditions of damaged BBB:

▪ Froin syndrome, ▪ Tubercular (TB) meningitis:

blocked CSF circulation through the subarachnoid space

▪ Froin syndrome,

web-like pellicle seen after overnight refrigeration of the fluid

Tubercular (TB) meningitis:

Findings: macrophages containing ingested RBCs (erythrophagocytosis) or hemosiderin granules

Cerebral hemorrhage - `

test (indicates fibrin formation at a hemorrhage site)

Positive D-dimer Cerebral hemorrhage -

Count – routinely performed on CSF specimen

WBC

determined only when a traumatic tap has occurred and a correction for leukocytes or protein is desired

RBC Count

how to calculate bc count

(Total count – WBC count = RBC count

– normal cell count for adult

* 0 to 5 WBCs/µL

mononuclear cells/ µL for neonates

in csf All diluents should be checked__________for contamination by examining them in a counting chamber under________

All diluents should be checked biweekly (twice a week) for contamination by examining them in a counting chamber under 400× magnification

Lymphocytes and monocytes in CSF

In adult – 70:30 - 70% lymphocytes - 30% monocytes

: Lymphocytes and monocytes IN CSF

In children – 30:70 - 30% lymphocytes - 70% monocytes

Presence of increased numbers in any other type of WBC other than lymphocyte and monocyte

PLEOCYTOSIS

LYMPHOCYTE IN CSF

NORMAL, VIRAL, TB, FUNGAL MENINGITIS AND MULTIPLE SCLEROSIS

Bacterial meningitis Early cases of viral, TB and fungal meningitis

Neutrophils

Viral and tubercular meningitis

macrophage

Normal Chronic bacterial meningitis Viral, TB & fungal meningitis; MS

Monocytes

Acute Leukemia Myeloblast or Lymphoblast

Blast cells

Multiple sclerosis

Plasma cells

Ependymal and choroid cells

Trauma and diagnostic procedure

Metastatic carcinoma (seen in clusters with fusing borders & nuclei)

Malignant cells

id for G- bacteria, rapid

Limulus Lysate

Abnormal values result from: o Alterations in the permeability of the BBB o Increased production or metabolism by the neural cells in response to a pathologic condition

platelets in csf

– most common chemical test

* Total protein determination

PROTEIN Normal reference values =

15 to 45 mg/dL

* is the second most prevalent fraction in CSF

Prealbumin

* is the major beta globulin present

Transferrin

– carbohydrate-deficient transferrin fraction, seen in CSF and not in serum

TAU

* major CSF gamma globulin

Immunoglobulin G (IgG) -

Clinical Significance of Elevated Protein Values

o Damage to the blood–brain barrier - Meningitis, multiple sclerosis, and hemorrhage conditions o Immunoglobulin production within the CNS o Decreased normal protein clearance from the fluid o Neural tissue degeneration o Other neurologic disorders

* Abnormally low PROTEIN values =X

* Abnormally low values = fluid leakage from the CNS

METHODS OF PROTEIN DETERMINATION .

TUBIDIMETRIC TCA and SSA - Simple, inexpensive, no instruments, large volume (>.5) . COLORIMETRIC - Lowry, CBB, Ponceau S, Biuret - Sensitive, smaller amounts . IMMUNOLOGIC - Expensive, smallest sample · AUTOMATED

-Colloidal Gold -Pandys

Antiquated

CAUSE OF HIGH CSF PROTEN

1. Meningitis 2. Multiple sclerosis 3. Hemorrhage

Causes of low CSF protein

1. CSF leakage

ELEVATED VS LOW CSF VALUE

ELEVATED = DUE TO PLASMA ELEVATION LOW = DIAGNOSTIC FOR

CSF Flashcards

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