cerebrospinal fluid 2

7/25/2019 Cerebrospinal Fluid 2

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Cerebrospinal FluidCerebrospinal Fluid

PjfvselisanarmtPjfvselisanarmt

CEREBROSPINAL FLUID

pjfvselisanarmt


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Types of FluidsTypes of Fluids

TransudateTransudate is uid pushed through the capillary dueis uid pushed through the capillary due

to high pressure within the capillaryto high pressure within the capillary

ExudateExudate is uid that leaks around the cells of theis uid that leaks around the cells of the

capillaries caused by inammation.capillaries caused by inammation.


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TR!"#$T%"TR!"#$T%"

$ecrease plasma albumin$ecrease plasma albumin

&ncrease venous pressure&ncrease venous pressure

&ncrease venous obstruction&ncrease venous obstruction Cardiac failureCardiac failure

$isturbance of circulation with$isturbance of circulation with

passive congestion and edemapassive congestion and edema


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%'#$T%"%'#$T%"

$amage of mesothelial linings$amage of mesothelial linings


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C(&!&C( C)!$&T&)!"C(&!&C( C)!$&T&)!"

TransudatesTransudates

*ypoproteinemia*ypoproteinemia

Congestive heart failureCongestive heart failure

(iver cirrhosis(iver cirrhosis

%+udates%+udates


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T,P%" )F %'#$T%"T,P%" )F %'#$T%"

"erous"erous

FibrinousFibrinous

"ero-brinous"ero-brinous PurulentPurulent

*emorrhagic*emorrhagic

PutridPutrid ChylousChylous

"erosanguinopurulent"erosanguinopurulent


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Diffrences Transudates Exudates

Origin Non-inflammator Inflammator

p! Al"aline A#i$i#

Spe#ifi# gravit %&'(&)*%&'(&+ ,&'(&)',&'(&+

Coaglation No #lot Clot formation presentProtein %.'( grams ,.'( grms

/l#ose Same 0it1 2loo$ gl#ose Lo0er t1an 2loo$ gl#ose

LD! %3(( IU*L ,3(( IU*L

C1lori$e Lo0er t1an 2loo$ #1lori$e !ig1er t1an 2loo$ #1lori$e

Cells Lmp1o#tes4rare5 Netrop1il 4P6N5

Crstals a2sent Present


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Cerebrospinal FluidCerebrospinal Fluid

PjfvselisanarmtPjfvselisanarmt

CEREBROSPINAL FLUID

4 li7or #ere2rospiralis5

pjfvselisanarmt


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rief historyrief history Robertson claims thatRobertson claims that

C"F came fromC"F came fromamniotic uid byamniotic uid by

conversion of theconversion of the

colloidal moleculescolloidal molecules

throughout thethroughout the

embryonic life.embryonic life.

$omenico Felice Cotugno$omenico Felice Cotugno/ 01234/ 01234

The third major uid ofThe third major uid of

the body.the body.


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The Flow of C"FThe Flow of C"F


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&mportance 5&mportance 5

cts as a mechanical bu6ercts as a mechanical bu6er "erves as an e+cretory channel"erves as an e+cretory channel

"erves as a nutrient to the brain"erves as a nutrient to the brain


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&mportance of C"F nalysis&mportance of C"F nalysis

To detect infection 7 to di6erentiateTo detect infection 7 to di6erentiate

meningitismeningitis

To detect C!" disordersTo detect C!" disorders

To detect subarachnoid blockTo detect subarachnoid block


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8ethod of Collection8ethod of Collection

0. (umbar0. (umbar

puncturepuncture

"ite"ite

9 lumbar :9 lumbar :

7373

/adults4/adults4

9 lumbar 3 79 lumbar 3 7

;; /children4/children4


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(umbar Puncture(umbar Puncture


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Cisternal PunctureCisternal Puncture

RecommendeRecommende

d in casesd in cases

of paralysisof paralysis

andandmeningitismeningitis


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The !eedleThe !eedle


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TubesTubes

0st tube =0st tube = chemistrychemistry

and serologyand serology

>>ndnd

tube =tube =microbiologymicrobiology

sectionsection

::rdrdtube =tube =

hematology sectionhematology section 33ththtube =tube = additionaladditional

testtest


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8acroscopic %+amination8acroscopic %+amination


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'antochromic/pale pink to'antochromic/pale pink to

orangeAyellow4orangeAyellow4 Causes5Causes5

*gb.*gb.

9old hemorrhageAlysed rbc9old hemorrhageAlysed rbc

ilirubinilirubin

9RC breakdown9RC breakdown

ProteinProtein

9 Rbc breakdown9 Rbc breakdown

8elanin8elanin

98eningeal98eningeal

melanosarcomamelanosarcoma


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BrayishBreenishBrayishBreenish

Cause5Cause5

increase pus cellsincrease pus cells

99acute meningitisacute meningitis


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$&FF%R%!T&T&!B "#9RC!)&$ ()CD$&FF%R%!T&T&!B "#9RC!)&$ ()CD

FR)8 TR#8T&C TPFR)8 TR#8T&C TP

"#9RC!)&$"#9RC!)&$

()CD()CD

%ven distribution%ven distribution

of bloodof blood

Clot formationClot formation

Presence ofPresence ofsiderophagesiderophage

Euekensted testEuekensted test

TR#8T&C TPTR#8T&C TP

#neven#nevendistribution ofdistribution of

bloodblood

!o clot!o clot !o siderophage!o siderophage

$9dimer /94$9dimer /94


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Euekensted test / Tobey9yer test4Euekensted test / Tobey9yer test4

8ethod used8ethod used

to detect sub9to detect sub9

arachnoidarachnoid

blockblock

$one by$one by

comprising thecomprising the

internalinternaljugular veinjugular vein


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CHEMICAL EXAMINATION OF CSF


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ProteinProtein

!ormal value5 0;93;mgdl!ormal value5 0;93;mgdl

&ncrease C"F protein may be found in&ncrease C"F protein may be found in55

&nfectionsA meningitisA multiple&nfectionsA meningitisA multiple

sclerosisA hemorrhagesclerosisA hemorrhage


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Eualitative testEualitative test

Ross onesRoss ones

!onne apelt!onne apelt

Pandy@s testPandy@s test !oguchi@s test!oguchi@s test


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Euantitative TestEuantitative Test

Turbidimetric methodTurbidimetric method !ephelometric method!ephelometric method

$ye binding techniGue$ye binding techniGue

iuret methodiuret method


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Blucose &n C"FBlucose &n C"F

)ormal *alue)ormal *alueH ;I 9JI mgdlH ;I 9JI mgdl +ncrease in+ncrease in55

diabetes mellitusdiabetes mellitus

&nfectious encephalitis&nfectious encephalitis

,ecrease in -,ecrease in - *ypoglycemia*ypoglycemia

Pyogenic meningitisPyogenic meningitis

Fungal miningitisFungal miningitisTo+oplasmosisTo+oplasmosis

"ub arachnoid hemorrhage"ub arachnoid hemorrhage

Primary tumor of the brainPrimary tumor of the brain


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ComparisonComparison

Ba#terialBa#terial

meningitismeningitis8iral8iral

meningitismeningitis92er#lar92er#lar


/l#ose/l#ose $e#rease$e#rease normalnormal De#reaseDe#rease

CellsCells P6NP6N lmp1o#teslmp1o#tes lmp1o#teslmp1o#tes


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ChloridesChlorides

!ormal value5 00:90>1 8%E(!ormal value5 00:90>1 8%E(

Tests5Tests5 "chales 7 "chales"chales 7 "chales

Cotlove chloridometerCotlove chloridometer


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(actate(actate

!ormal vaule 5!ormal vaule 5 !ewbornK 0I9>> mgdl /0.0 to 2.1!ewbornK 0I9>> mgdl /0.0 to 2.1

mmol(4mmol(4

)lder children 7 adults H L.I 9>2)lder children 7 adults H L.I 9>2mgdl/0.I H >.L mmol(4mgdl/0.I H >.L mmol(4

s adjuct to detect viral from bacterialAs adjuct to detect viral from bacterialAmycoplasma AtuberculousA and fungalmycoplasma AtuberculousA and fungal


8ethods5 automated analyMers8ethods5 automated analyMers


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BlutamineBlutamine

!ormal value5 J to 0J mgd(!ormal value5 J to 0J mgd(

Reects brain ammonia /ammonia NReects brain ammonia /ammonia Na9ketoglutarate4a9ketoglutarate4

&n cases of coma of unknown origin&n cases of coma of unknown origin


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C"F %nMymesC"F %nMymes

(actate $ehydrogenase/($*4(actate $ehydrogenase/($*4 #PP%R (&8&T5 3I #(#PP%R (&8&T5 3I #(

1I #(1I #(

&soenMymes5&soenMymes5

($0 and ($> 9 produce by the brain cells($0 and ($> 9 produce by the brain cells

($> and ($: H produced by the($> and ($: H produced by the

lymphocyteslymphocytes

($3 and ($; H produced by the($3 and ($; H produced by the

neutrophilsneutrophils


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Creatine DinaseCreatine Dinase

!ormal value5 O; #(!ormal value5 O; #(

O01 mgm(O01 mgm(

CD99 brain is the isoformCD99 brain is the isoform

CD9889 muscles is the isoformCD9889 muscles is the isoform

CD98CD98 HH brain and muscles is the isoformbrain and muscles is the isoform


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ParametersParameters BacterialBacterial iraliral Tu!ercularTu!ercular Fun"alFun"al

#BC#BCc$untc$unt

Ele%ated&NEle%ated&Neutr$'(ilseutr$'(ils

Ele%ated&l)m'Ele%ated&l)m'($c)tes($c)tes

Ele%ated&l)mEle%ated&l)m'($c)tes'($c)tes

*m$n$c)tes*m$n$c)tes

Ele%ated&Ele%ated&l)m'($c)tesl)m'($c)tes

andand

m$n$c)tesm$n$c)tes

Pr$teinPr$tein Mar+edMar+ed

increaseincrease

M$derateM$derate

increaseincrease

M$deerate t$M$deerate t$

mar+edmar+edincreaseincrease

M$derate t$M$derate t$

mar+edmar+edincreASEincreASE

,luc$se,luc$se Mar+edMar+eddecreasedecrease

N$rmalN$rmal DecreaseDecrease N$rmal $rN$rmal $r

decreaseddecreased

LactateLactateIncreaseIncrease N$rmalN$rmal IncreaseIncrease IncreasedIncreased

Ot(erOt(er

teststests

-./ Limulus-./ Limulus

l)sates 0it(l)sates 0it(

"ram-1/ $r""ram-1/ $r"

PelliclePellicle

f$rmati$nf$rmati$n-./ India in+-./ India in+

f$rf$r

cr)'t$c$ccuscr)'t$c$ccus

C$mm$nC$mm$n

a"entsa"ents

Enter$%irusesEnter$%iruses

234234

M5M5

Tu!ercul$sisTu!ercul$sis

C5C5

ne$f$rmansne$f$rmans


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!ote5!ote5

C"F leakage

usually present as )torrhea or Rhinorrhea

%lectrophoresis9garose gel

electrophoresis of concentrated C"Fwidely used to look for C"F )ligo Clonalbonds

C"F9)ligo Clonal bonds= J:9L3ofpatient with de-nite multiple sclerosis


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"erologic %+amination"erologic %+amination

C% Hmetastatic carcinomaC% Hmetastatic carcinoma

hCB H choriocarcinoma and germ cellhCB H choriocarcinoma and germ celltumorstumors

C"F ferritin H C!" malignancyAC"F ferritin H C!" malignancyApatients with inammatory diseasepatients with inammatory disease


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8icrobiologic %+amination8icrobiologic %+amination

0.0. "taining"taining

0.0. Bram stain H most importantA di6erentiatesBram stain H most importantA di6erentiatesbacterial pathogensbacterial pathogens

>.>. &ndia ink H C. neoformans and otheer fungi&ndia ink H C. neoformans and otheer fungi:.:. cid fast stain H tuberculous agentscid fast stain H tuberculous agents

3.3. uramine9Rhodamine stain H tuberculousuramine9Rhodamine stain H tuberculousagentagent

;.;. cridine orange H diferentiate amoebacridine orange H diferentiate amoeba/brick redI from leukocytes /bright green4/brick redI from leukocytes /bright green4

>.>. >. Culture>. Culture


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&mmunologic tests&mmunologic tests

0.0.CounterimmunoelectrophoresisCounterimmunoelectrophoresis

0.0.(imited for the detection and(imited for the detection and

identi-cation of5identi-cation of5

0.0.*. inuenMae H 0 month to ; years*. inuenMae H 0 month to ; years

>.>.". pneumoniae H >L yrs and older". pneumoniae H >L yrs and older

:.:.!. meningitidid H ; to >L yrs old!. meningitidid H ; to >L yrs old

3.3.%. coli H%. coli H

;.;.Broup "treptococciBroup "treptococci


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gglutination testsgglutination tests

0.0.(ate+ gglutination tests(ate+ gglutination tests

For bacterial antigen tests /Ts4A forFor bacterial antigen tests /Ts4A for

C. neoformansC. neoformans

>.>.%(&"%(&"


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(imulus lysate ssay(imulus lysate ssay

0.0.For detection ofFor detection ofthe presence ofthe presence of

endoto+inendoto+in


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ssignment5ssignment5

0. ?hat is P8Q0. ?hat is P8Q a. Causative agenta. Causative agent b.Pathogen /cause of infection4b.Pathogen /cause of infection4 c. $iagnosis and $etectionc. $iagnosis and $etection

d. Treatmentd. Treatment

C"F cell count /Refrence range for adult andC"F cell count /Refrence range for adult andchildren4children4

bnormal wbcrbc count in the following5/speci-c4bnormal wbcrbc count in the following5/speci-c4 encephalitisencephalitis multiple sclerosismultiple sclerosis meningitismeningitis cerebral aneurismcerebral aneurism lymphoma in the brainlymphoma in the brain neurosyphilisneurosyphilis strokestroke deliriumdelirium


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T*!D ,)#

cerebrospinal fluid 2

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