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evaluation of csf
- 2. • Cerebrospinal fluid (CSF) is a clear fluid present in the ventricles of the brain, the central canal of the spinal cord, and the subarachnoid space. • CSF is produced in the brain by modified ependymal cells in the choroid plexus (approx. 50-70%), and the remainder is formed around blood vessels and along ventricular walls.
- 3. Functions of CSF • • • • • Protects, lubricates the brain Provides nutrients, removes waste 90-150 ml adult 10-60 ml in newborn Modulates pressure changes (Buoyancy) Serves as a chemical buffer to maintain constant ionic environment Serves as a transport medium for nutrients and metabolites, endocrine substances and even neurotransmitters
- 4. Circulation of CSF Lateral ventricles interventricular foramen of Monroe third ventricle mesencephalic aqueduct (aqueduct of Sylvius) fourth ventricle spinal cord central canal; also, out the lateral apertures to the subarachnoid space to the venous system
- 6. Normal CSF • Thin, colourless, clear fluid • Pressure 90-180mm WATER (10-100 neonates) • 0-5 WBC’s /mm3 (neonates 0-30/ mm3 ) (Lymphocytes & monocytes) • Occasional ependymal or choroid plexus cells • Protein 15-45mg/dl • Glucose 50-80mg/dl • Chloride 113-130 mEq/L • Sterile
- 7. • Appearance • Normal - Crystal clear, colorless • Descriptive Terms – hazy, cloudy, turbid, milky, bloody, xanthrochromic • Often are quantitated – slight, moderate, marked, or grossly. • Clots indicate traumat tap • pellicle formation –cobweb • Milky – increased lipids • Oily – contaminated with x-ray – media
- 9. • Xanthrochromic – Yellowing discoloration of supernatent (may be pinkish, or orange). • Most commonly due to presence of ‘old’ blood. • Other causes include increased bilirubin, carotene, proteins, melanoma
- 10. Traumatic collection vs cerebral hemorrhage • Cerebral hemorrhage • Even distribution of blood in the numbered tubes • Clot formation possible • Xanthrochromic supernatent • – RBCs must have been in CSF @ 2+ hours • - D-dimer, fibrin degradation product from hemorrhage site • Microscopic presence of erythrophages, or siderophages, Hemosiderin granules
- 11. Lumbar puncture • a lumbar puncture (or LP, and colloquially known as a spinal tap) • is a diagnostic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis
- 13. indications 1. To obtain CSF sample for cytological,chemical,cellular and bacteriological examination 2. To aid in therapy by the administration of soinal anesthetics and occasionally antibiotics or antitumor agents or by reduction of CSF pressure 3. To inject radiopaque substance as in myelography, or a radioactive agent , as in radionuclide cisternography.
- 14. complications 1. 2. 3. 4. 5. Headache Brain herniation Diplopia Subarachnoid haemorrhage Spinal epidural hematoma
- 16. COMMON FORMS OF MENINGITIS CONDITION PRESSURE LEUKOCYTE PROTIEN GLUCOSE COMMENTS Aute bacterial Elevated(100- 100-10,000 300) Usually PMN’s 100-500 Reduced <40 < 50% of s.glucose Gram stain or culture Partially treated Normal/eleva 5-10,000 ted Usually PMN’s/mono nuclear cells 100-500 Normal/redu ced Gram stain or anitgen detectionby agglitination test Viral meningitis Normal or slightly elevated 50-200 Normal or reduced <40 Viral cultures/PCR, CT/MRI Rarely >1000 cells.intiallly PMN then lymph
- 17. Uncommon forms CONDITION PRESSURE LEUKOCYTE PROTEIN GLUCOSE COMMENTS TBM Usually elevated 10-500, all lymphocytes 100-300, higher due to block <50 % CSF is turbid with cobweb coagulum/PC R syphilis Usually elevated 5-500 , all lymphocytes 50-200 Usually normal CSF serology Amoebic elevated 1,000 – 50-500 10,000,PMN’s normal Mobile amoeba in hanging drop CSF exam.
- 18. Fungal meningitis ORGANISM WBC’s PROTIEN GLUCOSE SMEARS SEROLOGY CULTURES blastomyce 15,000(PM s N’s/lymph) 300 normal rare No good rare candida 600-1900 (mixed) elevated low 40% positive No good useful coccidioide s 100750(lymph ocytes) 150-2000 21 – 62% rare Antibody positive in 95% cases Positive in 60 % cryptococc us 40 – 400(lymph ocytes) high low India ink positive (25-50%) Antigen positive(90 %) Positive in 75% histoplasm a 0– normal 300(mixed) Low(<40) rare Antigen positive (61%) Positive (27-65%)
- 19. Brain abscess and parameningeal focus condition pressure leukocyte protein glucose comments Brain abscess Elevated(100300) 575-500 200(lymphocy tes) normal Sterile,unless ruptures Subdural empyema Elevated(100300) 1005000(PMN) 100-500 normal sterile Cerebral epidural abscess normal 100100-500 500(lymphocy tes) normal sterile Spinal epidural abscess low with spinal block 1050-400 100(lymphocy tes) normal sterile 1001000(PMN) Normal or decreased Epithelial cells with dermoid Chemical(dru elevated gs,dye,dermoi 50-100
- 20. noninfectious condition pressure leukocyte protein glucose others sarcoidosis normal 0100(monon uclear) 40-100 normal none SLE elevated 0-500(PMN) 100 Normal or decreased Culture sterile Tumors/leuk Elevatedto emia very high 0-100 50-1000 Normal to decreased Cytology positive SAH Normal increased normal xanthochro mia Opening pressure high