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42 Cards in this Set
- Front
- Back
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In what 2 sites is CSF formed?
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1. 70% in choroid plexus in lateral/3rd/4th ventricles.
2. 30% in ependymal lining of ventricles/subarachnoid space. |
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What 'actions' allow CSF to be formed?
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1. Filtration by capillaries
2. Active secretion by epithelial cells. |
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Describe CSF composition:
-K+ Ca2+ Bicarb, Glucose/Protein -Sodium/osmolarity -CSF acidity |
-K+, Ca++, Bicarb, Glu and Protein are lower than blood.
-Sodium/osmolarity are same. -More acidic than plasma. |
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What can get into the Brain past the BBB without help?
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Only water! Relatively permeable to it in fact.
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What diffuses through the BBB?
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Lipid-soluble substances.
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What is transported actively into the brain?
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Glucose, Sodium, Chloride, Mg.
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What are the 3 ways to enter the CSF?
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1. Diffuse if lipid-soluble
2. Facilitated/Active transport 3. Ion channels |
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What causes CSF circulation?
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Pressure changes caused by:
-Postural -Respiratory -Circulatory |
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What are the 3functions of CSF?
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1. Nourish brain
2. Take away wastes 3. Cushion from trauma/float. |
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What are 4 ways to collect CSF?
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1. Lumbar puncture
2. Cisternal puncture 3. Lateral cervical puncture 4. Ventricular cannular shunt |
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5 diagnostic indications for LP:
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-Meningitis/encephalitis
-Hemorrhage -MS/Guillan barre -Leukemia/lymphoma -Tumor/cancer |
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4 therapeutic indications of LP:
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-Chemotherapy
-Anesthesia -Radiographic contrast media -Amphotericin - for fungal meningitis. |
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Normal CSF pressure:
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50-180
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If there are only 1 or 2 tubes of CSF drawn, where do they go first?
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1. Micro
2. Heme 3. Chemistry |
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How Soon must CSF be run?
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Within ONE HOUR.
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What cells are normal on a CSF diff? in Whom?
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Adults: 65 lymph:35 mono
Newbrn: 70 mono: 30 lymph -Rare PMN -Rare choroid plexus, ependymal, neuroectodermal -Rare mesothelial |
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What are abnormal cells on a CSF diff?
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-PMNS many
-Lymphs many -reactive lymphs -Plasma cells -Macrophages |
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What is a siderophage?
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A macrophage that has hemosiderin in it.. and has been confirmed with PPB.
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Which cancers readily metastesize to the CNS?
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Breast
Lung |
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What do nRBCs indicate in the CSF?
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BM contamination.
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When are nRBCs normal in the CSF?
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When they are in the circulating blood of neonates.
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What might Eosinophils indicate when in the CSF?
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-Allergic rxtns
-Parasitic infections -C. immitis -Shunts, meds |
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What chemistries are most indicative of CSF abnormality?
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Protein
Glucose |
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What others might be run?
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Lactate
LD Glutamine |
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What is normal CSF Protein?
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15-45 mg/dL
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Why would CSF protein be low?
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Leaking CSF
-Otorrhea -Rhinorrhea |
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What are 4 methods for protein on CSF?
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-Turbometric
-Colorimetric -Spectrophotometric -Protein fractionation |
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What should the CSF:serum albumin index be?
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Less than nine.
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What should the gammaglobulin component of total protien be?
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Less than 12%
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If the gammaglobulin fraction is increased, what is suspect?
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-Inflammation
-Neoplasm -Cerebral disease -MS |
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What especially indicates multiple sclerosis?
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Oligoclonal bands on protein fractionation EVEN when symptoms go away.
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What 3 pieces of data help diagnose MS?
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-Increased IgG index
-Oligoclonal banding -Myelin Basic PRotein increase |
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What is normal CSF glucose?
What does Increase mean? What does Decrease mean? |
50-60% of the blood glucose
-Increase = increased blood glu -Decrease = diseased state |
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What is decreased CSF Glucose normally caused by?
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-Impaired transport across BBB
-Increased brain use -LEukocyte use |
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What is CSF glucose decrease usually seen in?
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-Bacterial meningitis
-Tubercular meningitis |
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What is normal LD?
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10-25 mg/dl
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When are Lactate and LD increased?
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-Oxygen deprivation to brain
-Bacterial, fungal, TB meningitis |
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When are Lactate and LD normal?
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viral meningitis
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what is glutamine masurement useful for?
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indicating CSF amonia levels
-elevated puts patients at risk of coma. |
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What are 6 tests used for microbiological and immunolog analysis of CSF?
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1. Gram stain
2. India ink 3. CIE 4. Latex agglutination 5. Ziehl-Neelsen 6. Limulus lysate |
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what is the limulus lysate test for?
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to detect gram negative rods.
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How does the limulus lysate test work?
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-Blood from horseshoe crabs has copper
-Coagulates in presence of GNB |
