Intro CSF Flashcards by Jess Fazekas

where is CSF fluid found

in subarachnoid space between pia mater and dura mater

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what are the spinal meninges

pia mater, arachnoid mater, and dura mater

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where is spinal fluid produced

choroid plexus

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blood brain barrier purpose

bidirectional siv between blood and spinal fluid

-keeps SF sterile

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how much SF is produced is produced every hour in an adult

20 mL

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at any given time how much SF does an adult have

90-150 mL

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at any give time how much SF does a child have

10-60 mL

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function of SF

-brings nutrients to cord and nerve tissue and remove waste products
-serves as cushion to protein brain and spinal cord

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only time looking for SF

spinal tap
lumbar puncture

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reasons for looking for SF

sus meningitis
diagnosis demyelinating disease
diagnosis subarachnoid hemorrhage
malignancy or cancerous growth diagnosis

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how to get SF?

-between L3 and L4 or L4 and L5
-xray to see
-fetal position opens up vertebrae
-lay flat for 30 min to an hour
-draw in tubes 1-4

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tube 1 goes to

chem and serology

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tube 2 goes to

micro
if multiple tubes give to micro
tube 2 will be cleaner
NO refrigerate!! kill of pathogens
STAT

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tube 3 and 4 goes to

heme
-blood will be in other tubes not this one if a traumatic tap

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if only can get 1 tube

MICRO- less risk of contamination

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if any SF left over

keep for 6 months frozen

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before and after taking SF need to measure

cranial pressure

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how to measure pressure of SF

manometer and needle

once drawn should be 90-180 mL mercury

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how much SF to remove for a norm adult

20 mL

if rapid decrease STOP

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once done pressure should not drop more between

10-30 mg

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if pressure is above or below certain values

> 200 or <90 make decision and only take 2 mL

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appearance of SF

clear

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1st thing done when get SF

macro description

always note TURBIDITY- seen in meningitis

blood?

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traumatic tap in tubes looks like

blood decreases as # of tubes increase

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#1 reason for seeing RBC in SF

traumatic tap

what does hemorrhage look like in tubes

of RBC evenly distributed in all tubes -no clotting

what does xanthochromic mean

slightly yellow or pinkish

what can cause xanthochromic SF

bilirubin -seen in neonates because immature liver and nRBCs

what no xanthochromic/bili in traumatic tap

not sitting around long enough

what does micro look for

meningitis always cytocentrifuge anything in SF can cause meningitis

neisseria meningitis

#1 cause of mening. gram - diplo cocci

haemophilus influenze

#2 cause gram - rods

beta strep group B

gram + cocci

strep pneumoniae

lancaid shape gram + cocci; elongated

what to use in gram stain for SF

acridine orange -small amounts of bacteria and gets rid of cellular debris

to plate SF what plates and broth

BAP and choc cooked meat or thioglycolate

if only 1 tube given what media and broth

choc- haemophilus cooked meat broth

TB in sterile fluid

no digest procedure because no normal fluid to get rid of

other things found in SF

classic TB- spider web like -enhanced in fridge fungal culture -cryptococcus neoformans - AIDS -india ink parasites -naegleria fowleri

viral meningitis

no testing -send out NOT as deadly as bacterial

first thing done with SF in chem

glucose values : 70% of serum values need blood glucose first; 30 min later SF glucose

look for a decrease in glucose values bc

#1 bacterial meningitis #2 malignancy and hemorrhaging no reason to see increase in glucose

#2 thing to look for SF chem

protein normal 15-45 in SF

normal protein in serum

6.5-8

INCREASE in protein = bad in SF

bacterial meningits classic is increase protein and decrease glucose

decrease in protein could be

spinal fluid leak or hyperthyroidism

normal protein in SF

prealbumin albumin tau protein IgG

tau protein

form of transferrin -only found in SF!!!!

new name of prealbumin

transthyretin

not normal protein in SF

IgA and IgM CAN:T cross barrier

to determine if blood brain barrier leak

more protein will leak into spinal fluid

how to determine if damage or synthesized protein??

spinal fluid to albumin ratio

equation for SF: albumin

SF albumin mg/dL / serum albumin g/dL normal <9 >9 damage to barrier

if abnormal proteins in SF normally means

MS- damage to myelin sheath synthesize IgG

test for MS

IgG index

abnormal protein MS in gamma region

oligoclonal band- only seen in SF 90% patients with MS have correlate both with serum

another abnormal protein seen in SF

myelin basic protein

mylein basic protein

autoantibody against sheath

glutamine

abnormal protein in SF -if found =liver failure -breakdown product of ammonia

reye's syndrome

seen in children from taking aspirin during viral infection -fatty infiltration of liver

lactate

abnormal protein seen in SF -due to inflammatory response or hypoxia

lactate > 25 helps diagnose

bacterial meningitis

when can't you do levels of lactate

on traumatic tap because lactate found in RBC and falsely increase

#1 test for in serology

neurosyphilis

screening tests for syphilis

RPR- rapid plasma reagin VDRL- venereal disease research lab both look non specifically for reagin

RPR

antigen comes premade with charcoal and choline chloride CANNOT dilute

VDRL

made daily antigen -only FDA approved for SF no choline chloride or charcoal -we can dilute ONLY USED for SF

we need to dilute antigen in VDRL because

too much antigen= post zone

other serology test for SF

cryptococcus antigen

what can give a false + in cryptococcus antigen

rheumatid factor in RA this is IgM produced against altered IgG

SF can't be put onto automated analyzer

not enough cells

adding albumin to a slide with concentrated SF

draws cells based on a charge

in heme do RBC count only if

true hemorrhage

if a traumatic tap and need to destroy RBC's use

glacial acetic acid

when to do WBC count on SF

at least 1 hr of coming down or else will falsey decrease if left out use hemocytometer

newborn normal cells are

monocytes

increase in neutrophils

bacterial meningitis

for a diff for SF

count 30 cells and report as %

not uncommon to see ____ in neonates

nRBCs

when would you see brain matter in SF

after surgery OR leukemia

large cells with round nuclei, frayed edges

lining cells

macrophage with ingested RBC

erythrophage indication of hemorrhage

macrophage with hemosiderin granules seen in

hemorrhage

malignant cells

abnormal weird shape most common signet