Csf- Dr. Fowler

Front 1

major indications for examination of CSF

Back 1

I- infections
S- subarachnoid hemorrhage
M- malignancy (CNS)
D- demyelinating disease
**meningeal infection is most important indication

Front 2

causes of elevation of CSF pressure on opening

Back 2

psychological and physical stuff- sitting up, tense, obese
diseases- CHF, SVC syndrome, venus sinus thrombosis
brain stuff- cerebral edema, hypo-osmolality, mass lesions, meningitis

Front 3

causes of depression

Back 3

spinal-subarachnoid block (shock situations), dehydration, circulatory collapse, and CSF leakage
*not as much of a concern as elevation

Front 4

do not remove >2ml if...

Back 4

1. OP > 200 mmH20- could herniate cerebellar tonsils
2. if pressure drops precipitously after removal of small amt- could indicate herniation or block in spinal canal

Front 5

4 tubes

Back 5

Chemistry
Cell Count
Critters (Microbiology)
Cytology (tumors)

Front 6

Emergency LP

Back 6

1. suspected meningitis
2. CNS leukemia
3. subarachnoid hemorrhage

Front 7

complications

Back 7

1. headache
2. precipitation of cerebellar tonsillar herniation
3. intro of infection
4. progression of paralysis

Front 8

xanthochromia

Back 8

pink to orange to yellow
1. pink-red to clear orange-red from oxyhemoglobin; w/in 2-4 hours, peaks at 24-36 hours, gone at 4-8 days
2. yellow from billirubin; after 12 hours, peaks at 2-4 days, persists for 2-4 wks

Front 9

other causes for xantho

Back 9

1. yellow- increased protein- bilirubin and carotene
2. yellow-red- merthiolate disinfectant contamination, rifampin therapy
3. brown- melanin

Front 10

high CSF protein...

Back 10

causes clot formation--may interfere with cell count by entrapping inflammatory cells; NOT seen in subarachnoid hemorrhage

Front 11

viscosity increased by...

Back 11

metastatic mucin-producing adenocarcinomas, cryptococcal meningitis, and nucleus pulposus injury

Front 12

WBC count normal

Back 12

adult <6 mononuc; 0 RBC
infant <19
neonate <30

Front 13

lymphocyte:monocyte

Back 13

70:30 in adults; opp in neonates

Front 14

pleocytosis

Back 14

pathological increase in the number of CSF leukocytes. reflects type, duration, and intensity of injury

Front 15

increased neutrophils

Back 15

bacterial meningitis in 70%
perisistent neutrophilia may be due to non-infectious causes or unusual organisms

Front 16

increased lymphocytes

Back 16

viral meningitis
non meningitis--MS, SSPE, sarcoid, vasculitis, chemicals, drugs, Guillain barre

Front 17

inc eosinophils

Back 17

eosinophilic meningitis
funcal infection- parasitic CNS, allergic rxn

Front 18

inc monocytes

Back 18

lack diagnostic specificity
"mixed cell reaction"

Front 19

mixed cell pattern

Back 19

if without neutrophils, then characteristic of early viral or syphilitic meningoencephalitis, otherwise in many conditions

Front 20

macrophages

Back 20

seen in hemorrhages
erythrophages appear 12-14 hours; siderophages appear 2-3 days. contain hemosiderin; macrophages may also contain hematoidin

Front 21

parts of micro exam

Back 21

1. gram stain- best rapid test for meningitis; 60-90% sensitive
2. cultures
3. latex agglutination (pediatric cases mostly) H.flu 90% and B strep.

Front 22

neurosyphilis

Back 22

1. darkfield microscopy- demonstrates spirochetes
2. VDRL- not very sensitive but it is very specific; used to confirm diagnosis, NOT to screen
3. FTA-ABS and RPR- not usually used b/c too sensitive, but negative test rules out disease

Front 23

viral meningitis

Back 23

1. enteroviruses- 80% of cases, peak in late summer
2. diagnosis of exclusion
3. viral culture is gold standard; other tests include immunofluorescence tests, brain biopsy, serologic methods, PCR in future

Front 24

HIV

Back 24

lymphocytic pleocytosis, elevated IgG indexes, oligoclonal bands, and identification of opportunistic infections.

Front 25

amebic meningoencephalitis

Back 25

caused by naegleria fowleri or Acanthamoeba species; trophozites may be visualized by light or phase contrast microscopy; acridine orange stain helps differentiate ameba from WBC

Front 26

elevated CSF protein

Back 26

assoc with xanthochromia, moderate pleocytosis, spontaneous clotting
1. increased perm of BBB
2. CSF circulation defects
3. increased IgG synthesis
4. increased IgG synthesis and blood-CSF permeability

Front 27

low CSF protein

Back 27

young children, removal of large volumes of CSF, CSF leaks, increased intracranial pressure, and hyperthyroidism

Front 28

albuminocytologic dissociation

Back 28

increased CSF protein within normal cells--classically Guillain Barre, but can be seen in other conditions

Front 29

normal glucose

Back 29

60% of plasma level; 50-80 mg/dl with rations of 0.3-0.9

Front 30

low glucose

Back 30

hypoglycorrhachia <40 mg/dl ratios <0.3

Front 31

tumor markers

Back 31

CEA- metastatic adenocarcinoma
HCG and DFP- germ cell tumor