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31 Cards in this Set

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major indications for examination of CSF
I- infections
S- subarachnoid hemorrhage
M- malignancy (CNS)
D- demyelinating disease
**meningeal infection is most important indication
causes of elevation of CSF pressure on opening
psychological and physical stuff- sitting up, tense, obese
diseases- CHF, SVC syndrome, venus sinus thrombosis
brain stuff- cerebral edema, hypo-osmolality, mass lesions, meningitis
causes of depression
spinal-subarachnoid block (shock situations), dehydration, circulatory collapse, and CSF leakage
*not as much of a concern as elevation
do not remove >2ml if...
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
4 tubes
Chemistry
Cell Count
Critters (Microbiology)
Cytology (tumors)
Emergency LP
1. suspected meningitis
2. CNS leukemia
3. subarachnoid hemorrhage
complications
1. headache
2. precipitation of cerebellar tonsillar herniation
3. intro of infection
4. progression of paralysis
xanthochromia
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
other causes for xantho
1. yellow- increased protein- bilirubin and carotene
2. yellow-red- merthiolate disinfectant contamination, rifampin therapy
3. brown- melanin
high CSF protein...
causes clot formation--may interfere with cell count by entrapping inflammatory cells; NOT seen in subarachnoid hemorrhage
viscosity increased by...
metastatic mucin-producing adenocarcinomas, cryptococcal meningitis, and nucleus pulposus injury
WBC count normal
adult <6 mononuc; 0 RBC
infant <19
neonate <30
lymphocyte:monocyte
70:30 in adults; opp in neonates
pleocytosis
pathological increase in the number of CSF leukocytes. reflects type, duration, and intensity of injury
increased neutrophils
bacterial meningitis in 70%
perisistent neutrophilia may be due to non-infectious causes or unusual organisms
increased lymphocytes
viral meningitis
non meningitis--MS, SSPE, sarcoid, vasculitis, chemicals, drugs, Guillain barre
inc eosinophils
eosinophilic meningitis
funcal infection- parasitic CNS, allergic rxn
inc monocytes
lack diagnostic specificity
"mixed cell reaction"
mixed cell pattern
if without neutrophils, then characteristic of early viral or syphilitic meningoencephalitis, otherwise in many conditions
macrophages
seen in hemorrhages
erythrophages appear 12-14 hours; siderophages appear 2-3 days. contain hemosiderin; macrophages may also contain hematoidin
parts of micro exam
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.
neurosyphilis
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
viral meningitis
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
HIV
lymphocytic pleocytosis, elevated IgG indexes, oligoclonal bands, and identification of opportunistic infections.
amebic meningoencephalitis
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
elevated CSF protein
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
low CSF protein
young children, removal of large volumes of CSF, CSF leaks, increased intracranial pressure, and hyperthyroidism
albuminocytologic dissociation
increased CSF protein within normal cells--classically Guillain Barre, but can be seen in other conditions
normal glucose
60% of plasma level; 50-80 mg/dl with rations of 0.3-0.9
low glucose
hypoglycorrhachia <40 mg/dl ratios <0.3
tumor markers
CEA- metastatic adenocarcinoma
HCG and DFP- germ cell tumor