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Flashcards in LP Deck (22):
1

LP

performed by inserting a hollow needle into the subarachnoid space----the area that carries CSF between the brain and spinal cord

2

CSF

Clear fluid that protects spinal cord composed of cells, water, proteins and sugars

3

What are the indications for perfoming a CT before LP

pt. older then 60
immunocompromised
pt. c cns lesions
pt. who has had a seizure 1 wk prior to presentations
AMS
Pt. with focal neurological findings

4

What is the most common neurologic manifestation of elevated ICP

Papilledema which can lead to blindness

5

Risk of LP

H/A
Infection
Numbness/pain Temp
Bleeding in spinal canal
may cause brain herniation

6

How to perform LP

Pt. lies on side with chich tucked to chest and kness to abd.
OR
Pt sits on the edge of the bed with arms draped over table positioned in front of pt.
Either postion back is arched, helps widen intervertebral spaces
Sterile proceduce, cleans back with antiseptic soliton plus drape with sterile towels, sterile gloves, anesthetize area, hollow needle bevel up. collect 10 drops in 4 test tubes
Position pt flat on back for 1 hr post procedure, rehydrate pt.

7

Where does a LP occur

L3-L4 or L4-L5

8

CSF Normal Values

Opening pressure:

9

Increase in neutrophils

bacterial meningitis, tubercular meningitis, cerebral abscess, subarachnoid bleed, tumor

10

increase in lymphocytes

viral, tubercular, fungal, syphilitic meningitis, MS, GB syndrome

11

Increase in Eosinophils

parasitic meningitis, allergic reaction to radiopaque dyes

12

Increase in macrophages

tubercular, fungal meningitis, hemorrhage, brain infarction

13

Increase in protein

infectious or inflammatory disease, meningitis, encephalitis, myelitis, CNS tumor

14

Decreased Gluscose

Bacterial, inflammatory cells or tumor cell
A CSF glucose level less then 60% of drawn blood glucose level may indicate meningitis or neoplasm

15

CSF change in color

Hyperbilirubinemia, hyperkarotenemia, melanoma, elevated protein levels= yellowish tinge
Cloudy= increase in WBC or protein

16

Bacterial Meningitis

Appearance: Clear, cloudy, or purulent

Opening pressure: Elevated (>25 cm H2o

WBC count: >100 cells/μL (>90% PMN); partially treated cases may have as low as 1 WBC/μL

Glucose level: Low (50 mg/dL)

17

Aseptic Viral Meningitis

Appearance: Clear

Opening pressure: Normal or elevated

WBC count: 10-1000 cells/μL (lymph but PMN early) •

Glucose level: >60% serum glucose (may be low in HSV infection)

Protein level: Elevated (>50 mg/dL)

18

Fungal Meningitis

Appearance: Clear or cloudy

Opening pressure: Elevated

WBC count: 10-500 cells/μL

Glucose level: Low

Protein level: Elevated

19

TB

Appearance: Clear or opaque

Opening pressure: Elevated

WBC count: 50-500 cells/μL (early PMN then lymph)

Glucose level: Low

Protein level: Elevated

20

Subarachnoid Hemorrhage

Appearance: Xanthochromia, bloody, or clear

Opening pressure: Elevated

WBC count: (1 additional WBC per 1000 RBCs is considered normal correction)

Glucose level: Normal

Protein level: Elevated

21

MS

Appearance: Clear

Opening pressure: Normal

WBC count: 0-20 cells/μL (lymph)

Glucose level: Normal

Protein level: Mildly elevated (45-75 mg/dL)

22

Guillian Barre Syndrome

Appearance: Clear or xanthochromia

Opening pressure: Normal or elevated

WBC count: Normal or elevated

Glucose level: Normal

Protein level: Elevated