CEREBROSPINAL FLUID BY Hossam HASSAN
-
Upload
leo-murphy -
Category
Documents
-
view
71 -
download
2
description
Transcript of CEREBROSPINAL FLUID BY Hossam HASSAN
![Page 1: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/1.jpg)
CEREBROSPINAL FLUIDCEREBROSPINAL FLUID BY BY Hossam HASSAN Hossam HASSAN
![Page 2: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/2.jpg)
Overview of Body Fluid Overview of Body Fluid AnalysisAnalysis
Laboratory exam of body fluidsPhysical characteristicsChemical constituents
Morphologic elementsCulture for microorganismsAncillary studies
![Page 3: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/3.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
Composition and formationCSF is the 3rd major fluid of the bodyAdult volume 90-150 mLNeonate volume 10-60 mL
![Page 4: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/4.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
Produced at the Choroid plexus of the 4 ventricles by modified Ependymal cells
At 90- 150 ml/day is produced
CSF flows through the Subarachnoid spaceWhere a volume of 90 – 150 ml is maintained (adults)
Reabsorbed at the Arachnoid villus / granulation
to be eventually reabsorbed into the blood
![Page 5: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/5.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)Blood Brain Barrier
Occurs due to tight fitting endothelial cells that prevent filtration of larger molecules.
Controls / restricts / filters blood componentsRestricts entry of large molecules, cells, etc.
Therefore CSF composition is unlike blood’s
**CSF is NOT an ultrafiltrate
![Page 6: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/6.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)Blood Brain Barrier
Essential to protect the brainBlocks chemicals, harmful substances
Antibodies and medications also blocked
Tests for those substances normally blocked can indicate level of disruption by diseases: ie meningitis and multiple sclerosis.
![Page 7: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/7.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
CSF functions
Supplies nutrients to nervous tissuesRemoves metabolic wastesProtects / cushions against trauma
![Page 8: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/8.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
Four major categories of disease
Meningeal infectionsSubarachnoid hemorrhageCNS malignancyDemyelinating disease
![Page 9: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/9.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
Indications for analysis
To confirm diagnosis of meningitisEvaluate for intracranial hemorrhageDiagnose malignancies, leukemia Investigate central nervous system disorders
![Page 10: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/10.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
Specimen collection and handling
Routinely collected via lumbar puncture between 3rd & 4th, or 4th & 5th lumbar vertebrae under sterile conditions
Intracranial pressure measurement taken before fluid is withdrawn.
![Page 11: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/11.jpg)
![Page 12: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/12.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
![Page 13: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/13.jpg)
CEREBROSPINAL FLUID (CSF)CEREBROSPINAL FLUID (CSF)•Specimen collection and handling
•Tube 1 – chemistries and serology•Tube 2 – microbiology cultures•Tube 3 – hematology
•Testing considered STAT•Specimen potentially infectious
![Page 14: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/14.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
Specimen collection and handlingIf immediate processing not possibleTube 1 (chem-sero) frozenTube 2 (micro) room tempTube 3 (hemo) refrigerated
![Page 15: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/15.jpg)
CEREBROSPINAL FLUID (CSF)CEREBROSPINAL FLUID (CSF)AppearanceNormal - Crystal clear, colorless
Descriptive Terms – hazy, cloudy, turbid, milky, bloody, xanthrochromic
Often are quantitated – slight, moderate, marked, or grossly .
Unclear specimens may contain increased lipids, proteins, cells or bacteria. Use precautions.
Clots indicate traumatic tap
Milky – increased lipids
Oily – contaminated with x-ray
media
![Page 16: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/16.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
AppearanceXanthrochromic – 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
![Page 17: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/17.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
AppearanceClots – indicates increased fibrinogen & usually due to traumatic tap, but may indicate damage to blood-brain barrier. (see below)
Pellicle formation in refrigerated specimen associated with tubercular meningitis.
Pellicle formation - picture at right (pellicle in L. tube, R is normal)
Milky – increased lipids
Oily – contaminated with x-ray media
![Page 18: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/18.jpg)
Traumatic collection vs Traumatic collection vs cerebral hemorrhagecerebral hemorrhage
Cerebral hemorrhage Even distribution of blood in the numbered tubes
Clot formation possibleXanthrochromic supernatent
–RBCs must have been in CSF @ 2+ hours -D-dimer, fibrin degradation product from
hemorrhage siteMicroscopic presence of erythrophages, or siderophages, Hemosiderin granules
![Page 19: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/19.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)Expected resultsNormally 0 RBCs/uL regardless of ageWBCsAdult – up to 5 mononuclear WBCs/uLNewborn – up to 30 mononuclear WBCs/uLChildren (1-4) - up to 20 mononuclear /uLChildren (5+) – up to 10 mononuclear / uLIncreased numbers = Pleocytosis
![Page 20: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/20.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
WBC counts
3% acetic acid can be used to lyse RBCMethylene blue staining will improve visibility
![Page 21: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/21.jpg)
Cerebrospinal Fluid (CSF)Cerebrospinal Fluid (CSF)
Correction of WBC count for traumatic tap contamination.
Uses ratio of WBCs to RBCs in blood and compares it to same ratio (WBC/RBC) in CSFIf patient’s peripheral cell counts are normal, can subtract 1 WBC for each 700 RBCs counted in CSF.
Great chance for considerable error, makes this of little value.
![Page 22: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/22.jpg)
Differential Diagnosis of MeningitisDifferential Diagnosis of Meningitis by Laboratory Results by Laboratory Results
Bacterial Viral Tubercular FungalIncreased WBC count Increased WBC count Increased WBC count Increased WBC count
Neutrophils Lymphs Lymps & Monos Lymphs & Monos
Marked ↑ protein Mod. ↑ protein Mod-Marked ↑ protein
Mod-Marked ↑ protein
Marked ↓ glucose ↔normal glucose ↓glucose Normal to ↓ glucose
Lactate > 35 mg/dL
Lactate normal Lactate > 25 mg/dL
Lactate > 25 mg/dL
+ gram stains Pellicle formation +India ink with Cryptococcus
neoformans
+bacterial antigen tests
+immunological test for C. neo.
![Page 23: CEREBROSPINAL FLUID BY Hossam HASSAN](https://reader035.fdocuments.in/reader035/viewer/2022062217/56813224550346895d98871a/html5/thumbnails/23.jpg)
THANK YOU