test of cerebrospinal fluid and serous membrance effusion
TRANSCRIPT
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Test of Cerebrospinal Fluid and Serous Membrane Effusion
Zhongsheng XiaZhongsheng Xia
The Second Affiliated Hospital, Sun Yat-sen UniversityThe Second Affiliated Hospital, Sun Yat-sen University
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Test of cerebrospinal fluid (CSF)
Test of serous membrane effusion
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Test of CSF
Indications and contraindications of lumbar Indications and contraindications of lumbar puncturepuncture
Normal reference value of CSF and clinical Normal reference value of CSF and clinical significance of abnormalitysignificance of abnormality
Characteristic changes of CSF in common Characteristic changes of CSF in common central nervous system diseasescentral nervous system diseases
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Test of serous membrane effusion
clinical significance of serous membrane effusionclinical significance of serous membrane effusion
Differentiation of transudate and exudateDifferentiation of transudate and exudate
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The cerebrospinal fluid (CSF)
Definition: CSF is a clear, colorless liquid that fills the ventricles, the subarachnoid spaces surrounding the brain and the spinal cord.
Anatomy:
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Indications of lumbar puncture patients with meningeal irritation signs patients are suspected to have intracranial hemorrhage patients with serious headache, coma, twitch or paralysis
contraindications of lumbar puncture patients with high intracranial pressure patients with local infection of the skin in the lumbar area
Test of CSF
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The position of lumbar puncture: The patient is placed in lateral kneel-chest position with the neck flexed
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http://www.chinavbox.cn/show/PWTVH3C3.html
Video for lumbar puncture
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General test Pressure: 80~180mmH2O, or 40~50drops/min
Increased: intracranial infection, intracranial hemorrhage, intracranial tumor, blood hypertension, cough, sneeze, et al.
Decreased: blocked circulation of CSF, CSF is lost,
shock, coma, dehydration, et al.
Test of CSF
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General test Color: colorless and clearColor: colorless and clear
milk white:milk white: pyogenic meningitis pyogenic meningitis
red:red: subarachnoid hemorrhage, traumatic hemorrhage, subarachnoid hemorrhage, traumatic hemorrhage, et al. et al.
yellow:yellow: old intracranial hemorrhage, CSF containing a old intracranial hemorrhage, CSF containing a lot of protein, serious jaundice, et al.lot of protein, serious jaundice, et al.
brown or black:brown or black: meningeal melanoma meningeal melanoma
Test of CSF
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General test Diaphaneity and clot: clear
cloudy or clot: meningitis
Test of CSF
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Chemical test Protein : Pandy’s test (-) Protein : Pandy’s test (-)
protein quantification: 0.15~0.45 g/L protein quantification: 0.15~0.45 g/L
increased:increased: encephalic infection, intracranial tumor, encephalic infection, intracranial tumor, intracranial hemorrhage, subarachnoid obstruction, intracranial hemorrhage, subarachnoid obstruction, et al.et al.
Separation of protein and cell:Separation of protein and cell: Guillain-Barre syndr Guillain-Barre syndromeome
Test of CSF
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Chemical test Glucose: 2.5~4.4 mmol/L
decreased: nervous system infection, intracranial tumor, hypoglycemia, et al.
increased: viral nervous system infection, diabetes, et al.
Test of CSF
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Chemical test chloride: 120~130 mmol/L
decreased: bacterial or fungal intracranial infection, hypochloremia, et al.
increased: chronic renal failure, hyperchloremia, et al.
Test of CSF
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Chemical test Enzyme: LDH=1/10 serum level, ADA=0~8U/L
high: nervous system bacterial infection,
cerebrovascular disease, cerebroma
Test of CSFTest of CSF
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Microscopic examination Cell count: white blood cell (0~10) ×106/L no red blood cell Cell differential: majority is lymphocyte neutrophil is increased: nervous system infection lymphocyte is increased: tubercular meningitis, fungal meningitis plasma cell: viral nervous system infection, tuberculosis, parasite, Guillain-Barre syndrome, et al. macrophage: meningitis, subarachnoid hemorrhage, brain trauma, et al. Pathogen: no pathogen
Test of CSF
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Characteristic changes of CSF in common central nervous system diseases
normal Pyogenic meningitis
Tubercular meningitis
Viral meningitis
Brain tumor Subarachnoid hemorrhage
Pressure
(mmH2O)
80~180 ↑ ↑ ↑ ↑ ↑
Gross appearance
clear cloudy mild cloudy clear or mild cloudy
colorless or yellow
red
Protein
(qualitative)
- + + + + +
Protein (g/L)
(quantitative)
0.2~0.4 ↑ ↑ ↑ ↑ ↑
Glucose
(mmol/L)
2.5~4.5 ↓ ↓ → or ↑ → ↑
Chloride
(mmol/L)
119~129 ↓ ↓ → → →
Cell count and differential (×106/L)
0~10 lymphocyte
↑ neutrophil
↑ lymphocyte ↑ lymphocyte
→ or ↑ lymphocyte
↑
red blood cell
Pathogen No Can be found
tubercular bacillus
virus No No
↑↑ : increased; ↓↓ : decreased; →→ : normal
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ascites
Pleural effusion
Pericardial effusion
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Test of serous membrane effusion General test
color
transudate: light yellow
exudate: dark yellow, red or milk white.
diaphaneity
transudate: clear
exudate: cloudy
gravity
transudate: <1.018
exudate: >1.018
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Chemical test Protein Rivalta test (qualitative analysis) transudate: negative exudate: positive quantitative analysis transudate: <25 g/L exudate: >30 g/L
Test of serous membrane effusion
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Chemical test
Glucose
transudate: similar to serum glucose
exudate: decreased
pyogenic inflammation: <1.12 mmol/L
tuberculosis: <3.30 mmol/L
malignant: 1.68~3.30 mmol/L
Test of serous membrane effusion
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Chemical test
Enzyme
LDH
transudate: similar to serum LDH
exudate: increased
ADA
transudate: similar to serum ADA
exudate: increased
Test of serous membrane effusion
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Microscopic examination
cell count
red blood cell
increased: malignant, tuberculosis, trauma
white blood cell
transudate: <100×106/L
exudate: >500×106/L
Test of serous membrane effusion
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Microscopic examination
cell differential
neutrophil increased: pyogenic, early tuberculosis
lymphocyte increased: tuberculosis, syphilitic, malignant
eosinophil increased: allergic disease, parasites, SLE, et al.
Test of serous membrane effusion
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Microscopic examination
cytology examination
cancer cell: malignant
Test of serous membrane effusion
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Differentiation of transudate and exudate
transudate exudate
Main cause not from infection or tumor infection, malignant, etc.
Gross appearance light yellow yellow, red or green
diaphaneity clear cloudy
Gravity <1.018 >1.018
Rivalta test negative positive
Protein quantitate <25 g/L >30g/L
Glucose Similar to serum glucose decreased
Cell count <100×106/L >500×106/L
Cell differential lymphocyte neutrophil, lymphocyte,etc
Pathogen
Fluid/serum Protein
Fluid/serum LDH
LDH
negative
<0.5
<0.6
<200 IU
can be positive
>0.5
>0.6
>200 IU
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uestionsuestions
1. What are the characteristic changes of CSF in common central nervous system diseases?
2. What are the differential points of transudate and exudate in serous membrane effusion?
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CSF is a clear, colorless liquid that fills the ventricles, the subarachnoid spaces surrounding the brain and the spinal cord. Its total volume is approximately 90~150ml.
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Measure pressure of CSF with manometer