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16 Cards in this Set
- Front
- Back
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in investigation for meningitis, what tests do you send the bottles for?
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1. bottle 1 (RCC, WCC)
2. (RCC, WCC, protein, glucose, grame stain) 3. RCC, WCC |
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how does SAH present?
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1. headache, neck stiffness, nausea
2. increased RCC in LP |
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What does CSF show in bacterial meningitis?
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1. elevated protein
2. <50% blood glucose 3. polymorph WCC 4 gram stain/culture |
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What does viral meningitis show in CSF?
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1. protein is mildly elevated
2. normal glucose 3. lymphoctes 4. PCR, viral culture |
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What does TB meningitis show in CSF?
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1. extreme elevated protein!!!
2. <50% glucose 3. lymphs and polymorphs 4. AFB stain 5, culture, PCR |
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What does fungal meningitis show in CSF?
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1. elevated protein
2. <50% blood glucose 3. lymphs 4. india ink, cryptococcal antigen, culture and PCR |
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Give 4 indications for lumbar puncture:
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1. suspected involvement of meninges by infection or malignancy
2. documentation of SAH 3. diagnosis of infectious or inflammatory conditions involving brain or spinal cord , excluding space occupying infections 4. documentation or treatment of intracranial HTN in pseudotumor cerebri |
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what are the contraindications to LP?
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1. intracranial mass leion (especially if rapidly progressive)
2. anticoagulation or bleeding diathesis 3. infection at the site of suspected LP |
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What are the complications of LP?
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1. headache (most common)
2. brain herniation (most dangerous, may occur several hours later) 3. other: a. corticol blindness b. cervical spinal cord infarction c. spinal hematoma with cord compression d. introduction of infection into the subarachnoid space e. development of intraspinal epidermoid tumor (rare) |
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What is a pellicle?
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proteinaceous clot that can occur from the very high protein levels in TB meningitis
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What does CSF show in MS?
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1. elevated IgG=oligoclonal band
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How much CSF is typically removed in a lumbar puncture?
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8-15ml
4-5 sterile containers containing 10 drops of CSF per bottle Number each bottle! |
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What are the components of routine CSF analysis?
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Volume
Appearance/colour White cell count Lymphocytes – viral Neutrophils - bacterial Red cell count Protein Glucose (compaired to serum glucose – N ratio 0.6) Presence of organisms (gram stain and culture) PCR – viruses(herpes), TB |
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How is CSF produced?
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By the choroid plexus in ventricles
Normal is 20mL per hour Normal volume is 125-150mL Reabsorbed by arachnoid villi – one way valve |
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What does the CSF look like in viral meningitis and what are the levels of cells, protein, glucose?
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Clear
WCC raised – predominant lymphocytes RCC normal Protein raised Glucose more than 50percent of serum concentration |
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What are the characteristics of bacterial meningitis CSF?
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Cloudy appearance
Raised WCC – predonminantly neutrophils RCC normal Protein raised Reduced CSF glucose (ratio less than 2/3rds) Organisms seen in CSF |
